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Office of the Vermont Attorney General

2020 Return to Work Screening Survey

2020 Return to Work Screening Survey

Potential symptoms of COVID-19 include fever, shortness of breath, cough, sore throat, chills, muscle pain, and recent loss of taste or smell. If you have any of these symptoms, unless they are a result of a condition known to you that is unrelated to COVID-19, you may not enter any AGO facility. If you do not have any of these symptoms, please complete and electronically sign this form before going into the office.
I have not felt feverish within the last 24 hours, have taken my temperature today with a thermometer, and do not have a temperature of 100.4°F or higher. *
I have not had any of the following symptoms within the past 24 hours, unless they are a result of a condition known to me that is unrelated to COVID-19: cough, shortness of breath or difficulty breathing, chills, muscle pain, sore throat, or recent loss of taste or smell. *
I have not traveled out of state within the last 14 days for nonessential business, or have reviewed the current travel quarantine guidelines issued by the Vermont Department of Health and can enter an AGO facility consistent with the guidelines. *
I have not traveled out of state within the last 14 days for nonessential business, or have reviewed the current travel quarantine guidelines issued by the Vermont Department of Health and can enter an AGO facility consistent with the guidelines. *