COVID-19 Visitor Questionnaire

Please contact Markell Currault-Holmes, Human Resources Director, at (504) 593-0625 or mcurrault@deutschkerrigan.com if you have questions. Thank you for assisting us in our efforts to minimize exposure to COVID-19.

Deutsch Kerrigan Attorney/Staff Name

If yes, please list the countries visited and the dates of each visit.

Have you traveled on an airline or cruiseship in the past 7 days?

Yes
No

Do you currently have any of these symptoms?

Fever over 100.4
Persistent cough
Shortness of breath
Loss of taste or smell

If yes, please give the date of the test result.

To the best of your knowledge, have you been in close contact with an individual who has had any of these symptoms: Fever over 100.4, persistent cough, or shortness of breath

Yes
No

If yes, please give date of last contact.

To the best of your knowledge, have you been exposed to anyone currently waiting for COVID-19 test results?

Yes
No

If yes, please give the date of last contact.

Have you had the COVID vaccine?

Yes, I have had the first of 2 vaccine doses and am currently waiting to have my second dose.
Yes, I have been vaccinated with the one-dose vaccine
Yes, I have had 2 of 2 vaccine doses and have completed the vaccination process
No, I have not begun the process of being vaccinated.
I refuse to answer