Self-Identification Survey Self-Identification Survey "*" indicates required fields To prepare for a safe return to the office, we must understand some critical aspects of each individual’s specific situation. Please answer every question below to the best of your knowledge.Name* First Last Position Branch Location Exposure to COVID-191. Have you been exposed to COVID-19? Yes No 2. Do you live with anyone who has been exposed to COVID-19 in the last 14 days? Yes No High Risk Individuals3. Individuals who fall within one of these high-risk categories may be entitled to a temporary accommodation. If you fit into one of these categories and you would like to be considered for an accommodation, please check “Yes.” Human Resources will follow up with you individually. Yes No 4. Do you live with or regularly care for anyone who is high risk? Yes No Individuals with Childcare Concerns Cornerstone expects to follow applicable federal, state, and local guidelines on getting back to work. At this time, specific guidelines for opening childcare facilities remain uncertain. With that said, please answer the below questions to the best of your ability.5. At this time, are you responsible or sharing responsibility for childcare in your home? Yes No If you answered "yes" to the question above, will your childcare responsibilities allow you to work onsite during the following time periods: Monday-Friday, 8am -5pm OR your normally-scheduled working hours. Yes No Travel6. Have you or any immediate family members traveled outside of the United States in the last 14 days or been in close contact with anyone who has? Yes No 7. Do you use mass transit such as a bus or train to travel to work? Yes No Additional Limitations8. Are there any other limitations that would affect your immediate return to the worksite? Yes No If "yes" please explain in the box belowCAPTCHA