Work In Office Request
Office Location
*
Boca Raton
New York City
Philadelphia
Name
*
First
Last
Email
*
Date You Will Be In Office
Date Format: MM slash DD slash YYYY
Please confirm the below affirmations
*
I have been authorized to be in the office today
I have read the building, CDC and government guidelines and will abide by them
I will wear a mask when not at my desk (unless alone in an individual office)
I have not knowingly been in close or proximate contact (within 6 feet for a cumulative 15 minutes over a 24 hour period) in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19
I have not tested positive for COVID-19 in the past 14 day
I have not experienced any symptoms of COVID-19 in the past 14 days