COVID 19 Safety Submission Form Please enable JavaScript in your browser to complete this form.Contact InformationName *FirstLastEmail *Phone *Jobsite *Date *SymptomsIn the last 24 hours have you or anyone in your home experienced the following?Fever *NoYesCough *NoYesShortness of Breath *NoYesSore Throat *NoYesDiarrhea *NoYesOther ItemsIn the past 14 days have you or anyone in your homeBeen on an airplane? *NoYesBeen in Contact With Anyone Diagnosed With COVID-19? *NoYesWhat is your current temperature?Please take a reading of your current body temperature and report it here. If you answered "Yes" to any of the above, please immediately contact Tammy or Shelby at (517) 655-9272Submit
