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EMPLOYEE COVID-19 ACKNOWLEDGMENT FORM
The Company is committed to providing a safe workplace for our employees and our guests. To enable you to make an informed decision about returning to work given the risks associated with the potential spread of COVID-19 in the workplace, we want you to be aware that we are taking the following steps: Implementing hourly cleaning and disinfecting protocols, requiring physical distancing, requiring employees who are ill to stay home, requiring employees to wear masks, requiring employees to complete Daily Certifications as described below, installed Plexiglas shields at the payment station, removed tables where feasible and marked “no service” tables to ensure guest physical distancing and installed physical distancing floor markers for our guests. If you have any additional steps you think would help us minimize the spread of COVID-19 in the workplace, please share those suggestions with the General Manager or Assistant General Manager.
Until COVID-19 is brought under control or eradicated with a vaccine, we will continue to take reasonable steps to minimize the risk of spreading COVID-19 at work. However, some of our co-workers, visitors and guests will contract COVID-19 as they go about their daily lives. Some may have symptoms, but many may be completely asymptomatic. When our co-workers, visitors and guests come into the restaurant or worksite, they may expose us to the virus. So, we must make sure we are all doing our best not to bring the virus to work with us.
With that goal in mind, we will be asking every employee, every day to take a moment before they come to work to take stock of their health, take their temperature, and think about whether they may have been exposed to COVID-19 either through personal travel or because of close contact with someone who has been diagnosed with or experiencing symptoms of COVID-19. We will also ask every employee, every day to complete the attached Daily Certification to make sure they are safe to come to work. If you cannot certify that you are safe to come to work that day, then stay home and immediately contact your General Manager or Assistant General Manager so we can provide you with assistance and take the necessary steps to minimize the risk of spreading COVID-19 to your co-workers and our guests. As for our guests, we will be posting signage at the entry asking that they not enter if, among other things, they have symptoms of or have been diagnosed with COVID-19.
Prior to returning to work, please review the CDC Guidance concerning safety precautions that we should take every day and the applicable state guidance regarding restaurant operations. These documents should be presented to you as part of this acknowledgement process. Some individuals are more susceptible to contracting more serious illness and outcomes from the COVID-19 virus and may need to remain at home for the time being based on the specific CDC guidelines. We believe the decision to work outside the home is a decision that every employee should make in consultation with their own healthcare provider. If you have any concerns about returning to the workplace or your health, we encourage you to talk to your healthcare provider and then contact your General Manager or Assistant General Manager before returning to work. To the extent possible, we will try to work with you and consider reasonable accommodations when necessary.
By returning to work, you agree to do all of the following to protect your own health and those around you:
1. I agree to immediately leave the restaurant or worksite if I suddenly feel sick during the workday.
2. I agree to self-monitor my health for symptoms associated with COVID-19 and to carefully and truthfully complete the Daily Certification form before coming to work. I will seek treatment and/or advice from an appropriate health care provider if I have any COVID-19 symptoms and not report to work until I have discussed my situation with my General Manager or Assistant General Manager and received the Company’s permission to return to work.
3. I agree to avoid close contacts with individuals known to have COVID-19 infection without using all appropriate personal protective equipment (PPE). If I do have close contact with someone who I learn has COVID-19, I agree to immediately notify my General Manager or Assistant General Manager and not report to work.
4. I agree to maintain social distance (at least 6 feet) away from others at work to the greatest extent practicable.
5. I agree to wash or sanitize my hands at the start of my workday and at minimum every hour throughout the day.
6. I agree to wear a face covering when entering and leaving the restaurant or worksite and at all times when I am at work.
7. I agree to clean and disinfect my personal work area, including all frequently touched surfaces (computer keyboard, phone, work surface and door handles) at least 2 times per shift.
8. I agree to clean and disinfect any common or shared surfaces that I touch at least every two hours.
9. I agree to follow all of the Company’s other rules and practices put in place to help reduce the
spread of COVID-19 in the workplace.
10. I agree and acknowledge that despite taking all reasonable precautions to prevent the spread of
COVID-19 in accordance with CDC, state, and local guidelines, the Company cannot guarantee that I will not be infected.
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