Skip to main content
Dayforce
Main navigation
Home
Benefits
Medical
Dental
Vision
Life Insurance
Elective Benefits
General Healthcare Services
Benefit Rates
How to Change Benefits
Benefit Enrollment Forms
Commuter Subsidy
Employee Type Comparison Chart
Terms to Know
Travel
My Offerings
Regular Employee Working 20 Hours Weekly or More
Regular Employee Working 19 Hours or Less Weekly
Postdoctoral Fellow
Temporary Employees
Students
Interns
Volunteers
Retirement
Carnegie Contributory Retirement Plan
Carnegie Supplemental Annuity Plan
457(b) Deferred Compensation Plan
Prepare to Retire
Retiree Medical Insurance
Time Away
WorkLife
Employee Assistance Program
Health Tips
Carnegie Perks
Carnegie Retreat Properties
Education Assistance Program
Pet Insurance Discount
Ticketsatwork
New Hires
J1 Exchange Visitors
Careers
Application Process
Jobs
Visitor Health Check Form
Visitor Information/Información del visitante
Name
First Name/Nombre
Last Name/Apellido
Please provide a phone number where you can be reached/Por favor, proporcione un número de teléfono de contacto
Select the Carnegie campus you will be visiting/Seleccione las instalaciones de Carnegie que visitará
- Select -
1530 P St. NW Washington, DC
3520 San Martin Dr, Baltimore MD
5241 Broad Branch Road, NW Washington, DC
813 Santa Barbara St, Pasadena CA
260 Panama St, Stanford, CA 94305
Visit Date and Time/Fecha y hora de la visita
Visit Date and Time/Fecha y hora de la visita: Date
Visit Date and Time/Fecha y hora de la visita: Time
Your Company Name/Nombre de su empresa
Your Carnegie Contact/Su contacto en Carnegie
Have you had any of the symptoms below in the last three days? (please check all that apply) / ¿Ha tenido alguno de estos síntomas en los últimos tres días? (por favor, marque todos los que correspondan)
Cough / (Tos)
Fever / (Fiebre)
Chills / (Escalofríos)
Headache / (dolor de cabeza)
Muscle pain / (Dolor muscular)
Sore throat / (Dolor de garganta)
New loss of taste or smell / (Pérdida reciente del gusto o el olfato)
No Symptoms / (No tengo síntomas)
Prevention questions / Preguntas de prevención
Have you been wearing a mask when visiting other job sites? / ¿Ha usado mascarilla al visitar otros centros de trabajo?
- Select -
Yes
No
Do you practice social distancing while on other job sites? / ¿Practica el distanciamiento físico en otros centros de trabajo?
- Select -
Yes
No
Exposure questions / EXPOSICIÓN COMUNITARIA
Someone in my household has symptoms of COVID-19. / (Alguien en mi hogar presenta síntomas de COVID-19.)
Someone in my household tested positive for COVID-19. / (Alguien en mi hogar dio positivo en la prueba de COVID-19.)
I am currently caring for someone with possible COVID-19 symptoms. / (Actualmente estoy cuidando a alguien con posibles síntomas de COVID-19.)
I have recently returned from traveling outside the area within the last 14 days. / (Regresé hace menos de 14 días de un viaje.)
I have had contact with someone suspected of having COVID-19 within the last 14 days / (He tenido contacto con alguien sospechoso de tener COVID-19 hace menos de 14 días.)
None of the above / (Ninguna de las anteriores.)
Carnegie Requirements / Requisitos de Carnegie
I acknowledge that I am required to wear a mask while at any Carnegie location. / Acepto que debo usar una mascarilla al estar en cualquier lugar de Carnegie.
I acknowledge that if I begin to experience any COVID related symptoms in the next 14 days that I agree to contact Carnegie. / Acepto y estoy de acuerdo en contactar a Carnegie si comienzo a tener cualquier síntoma relacionado con el COVID en los próximos 14 días.
Submit