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Wellness Verification

By signing and initialing below, the following statements are agreed upon to be true and accurate to protect the safety, health, and well-being of those on the jobsite. If at any point throughout the shift symptoms begin to arise, it is understood that these must be immediately reported to jobsite supervision and if necessary, removed from the jobsite. Notification of any positive COVID-19 test result must be given to Tri-City Electric Company Human Resources Department as soon as possible upon receiving knowledge of results.

*Tri-City Electric Company’s Daily Wellness Verification form will be in effect throughout the COVID-19 Pandemic as deemed active by the World Health Organization.


1. I am currently fever-free and have been fever-free for the previous 24 hours without the use of fever-reducing medication. (A fever is defined as 99.5 degrees Fahrenheit or greater)
2. I am aware of the COVID-19 symptoms as published by the CDC and not currently exhibiting any known symptoms including body aches, shortness of breath, weakness, fatigue, or cough accompanied by any other symptoms.
3. I have not been deemed a close contact per CDC with anyone known to have a confirmed COVID-19 positive diagnosis
4. Any travel outside of Iowa or Illinois within the past 14 days has been discussed with Human Resources.
 
By signing below, I am acknowledging as foreman/supervisor that all TCE employees present today on the jobsite under my direction have been informed and agree to the statements above. If working alone, this statement is not applicable. By signing below, I am acknowledging that I agree to the statements above.