Employee Work Certification

Please submit daily.

Daily COVID-19

Employee Work Certification
For Rancho La Puerta, LLC

To reduce the risk of spreading the COVID-19 virus in and through the workplace and protect our employees, the Company is implementing procedures for observing whether any individual attempting to enter a Company facility has any symptoms of COVID-19 or related illness.

Pursuant to the CCPA, we are notifying you that we are collecting the following category of Personal Information: Medical and health information, specifically information related to your body temperature and whether you have or display certain medical symptoms.

The Company will maintain this information under conditions of confidentiality. We are collecting this information for purposes of reducing the risk of spreading the COVID-19 virus in and through the workplace and protecting our employees and guests.

I attest to the following “check any/all boxes that apply.” *

I have not had a fever at or above 99.5 degrees Fahrenheit for the past 10 days;

I have not experienced respiratory symptoms, including a cough or shortness of breath for the past 10 days; and

I have not experienced any flu-like symptoms for the past 10 days.

Should any of the above circumstances apply to you, please do not come to the worksite (or leave immediately), email and call Barry Shingle or Manuel Hernandez.

Comments:

Name: *

Date *

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Employee Work Certification

Please submit daily.