* = Required Information
Name
*
1.Have you experienced any cold or flu-like symptoms recently (including things like fever, cough, sore throat, respiratory illness, difficulty breathing) and not reported to the company because you feel like your job can be in jeopardize?
Yes
No
Please Explain
2. How did the company handle COVID-19?
• Did the company provide enough supplies for you and your co-workers?
Yes
No
• Are you forced to work even you are sick?
Yes
No
• Has your supervisor been available for questions/support?
Yes
No
• Do you have a copy of the company COVID-19 protocol?
Yes
No
•Is temperature required to be checked before you start your shift in the group home on a daily basis?
Yes
No
3. How often you was provided with the following:
Hand sanitizer
Once per week
When I requested
Gloves
Once per week
When I requested
Shoe Cover
Once per week
When I requested
Masks
Once per week
When I requested
4. Did your hours reduce because of the COVID-19?
Yes
No
5. Do you work more hours now than before the pandemic?
Yes
No
6. Do you believe that the agency provider(s) cares about your health and safety?
Yes
No
Why?
*
Submit