Main Menu Main Content COVID-19 DAILY HEALTH CHECK SELF-ASSESSMENT FORM Offices Inquiries COVID-19 Daily Health Check Self-Assessment Form Social Media Before entering any Bressler, Amery & Ross office location, all Bressler employees and visitors, whether fully vaccinated or not, must submit the Bressler COVID-19 Daily Health Check Self-Assessment form on a daily basis. The disclosure is required to safeguard health, safety, and limit transmission in the Bressler community. If you aren’t feeling well, even if you are fully vaccinated, stay home, contact your physician, and take care of yourself. Name* Email* Phone* Which Bressler location are you visiting?* BIRMINGHAM CHARLOTTE DALLAS FLORHAM PARK FORT LAUDERDALE HOUSTON MIAMI NEW YORK WASHINGTON, DC BIRMINGHAM Who are you visiting at Bressler?* Purpose of the visit if not a Bressler employee Check here if you are a Bressler Employee Are You Fully Vaccinated?* Yes No Covid Contact / Exposure / Symptoms Do you have a temperature higher than 99 degrees?* Yes No Have you had contact with or cared for someone diagnosed with COVID-19 within the last 14 days?* Yes No Do you have a household member who was exposed to COVID-19 within the last 14 days?* Yes No Have you experienced any cold or flu-like symptoms within the last 14 days (including fever, cough, sore throat, respiratory illness, or difficulty breathing)?* Yes No If you have responded ‘Yes’ to any of the above Exposure/Symptoms questions please contact Bressler’s HR Department at selfevaluation@bressler.com prior to your arrival at the office. Enter code shown below* * Indicates a required field. Jump to Page BIRMINGHAM, AL CHARLOTTE, NC DALLAS, TX FLORHAM PARK, NJ FORT LAUDERDALE, FL HOUSTON, TX MIAMI, FL NEW YORK, NY WASHINGTON, DC Home Contact Us COVID-19 Daily Health Check Self-Assessment Form Sign Up Site Map Disclaimer Privacy Policy © 2021 Bressler, Amery & Ross, P.C. All rights reserved. Attorney advertising Site by Firmseek By using this site, you agree to our updated Privacy Policy and our Terms of Use. Close