Health Questionnaire

REQUIRED
YOU MUST CHECK ACKNOWLEDGMENT AT BOTTOM OF THIS FORM

The purpose of this questionnaire is to conduct COVID-19 screening of all individuals attending in-person Alaska Safety Alliance classes. Because your health has the potential to affect the health of your classmates and instructor, as well as their families and others, please answer these questions honestly.

In the event someone in the class has been in close contact with someone probable or confirmed with COVID-19, your contact information is necessary so we can inform you that your health and safety may be at risk. All medical information will be treated confidentially and only disclosed to others when required to meet our obligation to maintain a safe workplace.