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  • Contact information

    Not you?
    Double check you entered the correct ID on the previous screen. If you are having issues with your account, please contact your HR representative or supervisor.
    Not you?
    Double check you entered the correct ID on the previous screen. If you are having issues with your account, please contact your HR representative or supervisor.

  • 1. Have you experienced any of the following symptons in the past 24 hours?

         These symptoms can be fever, cough, sore throat, nasal congestion, lack of smell / palate, headache, or any additional Symptoms.

  • 2. Have you been in close contact in the past 14 days with anyone who has tested positive or was clinically diagnosed with COVID-19?

  • How do you answer the above questions? Click your answer below.

    • Approved for Entry  
    • Entry Denied  

  • The information you provide on this form will be used to make and record facility entrance decisions in accordance with applicable screening guidelines. It will be kept confidential according to the applicable law and 3M Policies.

    3M may use your personal information (including sensitive data about your health) collected on this form for the purpose of controlling access to our facilities, which may be shared with those responsible for the Disease Prevention Coordination and Medical Services teams ("EHS"), and will be used in accordance with our 3M Global Data Privacy Policy, available at www.3m.com/privacy

  • Submit

Approved for Entry

You may now enter the building.


  • If I present any symptoms after I have completed this survey, I must report them to the DPC (Edith Batista, Cel: 6467-3855) and I must stay home until they tell me.
  • I declare that I agree to return voluntarily to work, without objection, and that if I have any risk, health or disability situation, I will notify my Supervisor, doctor or human resources
Thank You for completing the COVID-19 Screening Questionnaire.

Entry Denied

You may NOT enter the building.


  • If I present any symptoms after I have completed this survey, I must report them to the DPC (Edith Batista, Cel: 6467-3855) and I must stay home until they tell me.
  • I declare that I agree to return voluntarily to work, without objection, and that if I have any risk, health or disability situation, I will notify my Supervisor, doctor or human resources
Thank You for completing the COVID-19 Screening Questionnaire.

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Las marcas mencionadas arriba son Marcas Registradas de 3M.