Covid Questionaire

Covid Questionairre

Due to the recent Executive Order signed by the President, it appears that all employers in excess of 100 employees will be required to ensure that all of their employees be vaccinated against Covid-19, or, employees must be tested weekly and provide negative test results to the employer. The US Department of Labor (OSHA) is currently developing the rules around this new EO. You can read about the order and potential ramifications for employers and government employees here: Washington Post

This Questionnaire will help us determine how many of our staff are already vaccinated, how many will now become vaccinated, how many will require weekly Covid-19 testing, or how many will be requesting a recognized Religious exemption or valid medical exemption. This is for informational purposes only at this time.

Click here to complete the Questionnaire: https://fs4.formsite.com/presources1/covid/index.html

NOTE: This is an evolving process and policy due to potential challenges to the Executive Order, and the final rules that are being developed. F2OnSite is currently amending our Covid-19 policy with our attorneys. The situation and circumstances will change as time goes on, however, this Questionnaire will give us enough information to understand where the company is in regards to compliance.

Your answers will be confidential at this point and held by Human Resources. If you have any questions please reach out to Human Resources.

*Certain customers already require Covid-19 vaccinations. If that is the case, you will continue the process as explained previously. Regardless of the customer you support, please complete the questionnaire.

Your name *

What is the name of the Customer you support? Please be specific *

Work City: *

Work State *

Please select the appropriate situation that best describes yourself. NOTE: If you have had, or you have not had Covid in the past, please answer appropriately. In regards to the Covid 19 Vaccine: *

I am fully vaccinated

I am fully vaccinated and have submitted my card to F2OnSite previously

I have received at least one shot

I am not vaccinated, but I am willing to be.

I am not vaccinated and I am not willing to be

Other Other

If you are unvaccinated, check all those that apply:

I plan on getting vaccinated.

I will request a legitimate exemption due to organized religious requirements or beliefs

I will request a medical exemption and will provide documentation as required

I will not get vaccinated under any circumstances.

Other Other

If you have been vaccinated, do you have your CDC, State or other agency vaccination card? *

Yes, I am fully vaccinated and have my card.

Yes, I am vaccinated with at least one shot and have my card

NA. I am not vaccinated

I am vaccinated but do not have my card, please explain I am vaccinated but do not have my card, please explain

If you would like to upload your Covid-19 card please use this form: CDC Card Upload

Thank you for giving us this information. As with many companies across the Country, and the world, Covid-19 has disrupted not only our business but also our personal lives. Please continue to be safe, wear masks and maintain social distancing where possible. You will be required to provide more information soon, thank you for cooperating during this difficult time and as always, Thanks for being part of F2OnSite.