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A A R CAD IS Oesign&Consultancy <br /> forllaturaland <br /> builtassMs <br /> COVID-19 SELF ASSESSMENT <br /> Arcadis staff visiting offices and project sites must complete the COVID-19 Health Screening Self- <br /> Assessment Questionnaire prior to each visit.Arcadis staff can now use the H&S App to complete <br /> their daily(or multiple times a day,if appropriate)COVID-19 Health Screening Self-Assessment.The <br /> data entered into the H&S App COVID-19 Health Screening Self-Assessment form is not stored. <br /> COVI❑-19 SAFE Return O O <br /> Sc•II Assessulen! 5cnenuler <br /> Are you a Critical U.S. COVID-19 dlaammo e,1-6- <br /> Infrastructure/Essential w m 1..le 1r n movie l <br /> �,J( p�oHcclonal wuhm prcvlour ld <br /> Worker? �•J d:y. <br /> ! <br /> 0 CI­ca <br /> Clnbc!(6 11.121d)with <br /> COVIO-19 symplomallc Individual <br /> Have you had potential <br /> within 48 houn <br /> eve <br /> exposure Or close contact rpy(op Cleee canWe!(a n.IZM)with e <br /> i is ft./2M)with a COVI❑-19 f 4 CoID-19 poem,nra evduol <br /> symptomatic or confirmed 1f w;i pf°V1.. <br /> [!� positive individual withinoovlo-Isaymptoma <br /> the past 48 hours? lumLffll <br /> In Iasi 24 Mum or laver <br /> 00A-FWC) <br /> 4*Mtol-evel3countrywilhln <br /> pmvious 14 days <br /> I�h® <br /> 4�J Previous Observations <br /> Upon completion of the COVID-19 Health Screening Self-Assessment in the H&S App,the user will <br /> receive a green,yellow or red completion message(as shown below). <br /> • COVID-19 <br /> r <br /> Health Status Health Status <br /> You are good to go. Inform Project Manager Do not proceed with <br /> Please show this and review work-related visits today. <br /> confirmation prior to Guidance Document <br /> starting work. <br /> 0211 <br /> CAUTION! stop work <br /> Maintain Social Distancing Proceed only with Stay Home,Stay Safe <br /> Critical Infrastructure Work <br /> Tuesday,May 19,2020 Tuesday,May 19,2020 <br /> 1'1-39.30 11:39:58 <br /> Tuesday,May 19,2020 <br /> 113940 <br /> j.iiiiihitiiidiiaiii,� ,,creep shot and save Screen shot and save <br /> 6 <br /> Green-proceed to the office Yellow(Caution)-critical Red-do not proceed to the <br /> or project site infrastructure/essential worker office or project site <br /> must contact the Project Manager <br /> and review the"H&S App Yellow <br /> Caution Status Guidance" <br />