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.

Exposure to COVID-19

1. Have you been exposed to COVID-19?
2. Do you live with anyone who has been exposed to COVID-19 in the last 14 days?

High Risk Individuals

3. 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.
4. Do you live with or regularly care for anyone who is high risk?

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?
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.


6. 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?
7. Do you use mass transit such as a bus or train to travel to work?

Additional Limitations

8. Are there any other limitations that would affect your immediate return to the worksite?