COVID Screener Questions and Appointment Check-In - Telephone Check-In

Evaluate Alternatives:
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For SSA employee to consider during telephone interview:
o Are original documents absolutely required per policy or is there an exception?
o Can the customer submit evidence by any other method?
o Is there an online service the person can utilize?
o Is there another way to meet the customer’s need? For example, if the person
thinks he/she needs a social security card for proof, could an SSN printout
suffice?

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Questions/Directions for the Public:
o Do you have the required original documents?
o Can you mail the original documents to the office?
o Can the customer use a drop box? (If no, continue.)

Explain Limited Service Express Interview Process:
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“We will schedule a time for you to visit the office to submit your document in
person. This will be a 5-minute in person interview in which we will certify your
presented document and return the document to you.”
“During the in-person interview, we will not have time to discuss any other SSA
business.”
“We will be happy to discuss any additional business or questions you may have prior to
ending our current phone conversation.”

Screen Per EM-20028 SEN REV:
When scheduling the dire need in-office appointment, managers and designated staff must
perform the following actions:
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Remind the individual that only the individual, and if necessary someone assisting the
individual, should enter the office. Other visitors are not permitted.

Inform the individual that all visitors entering Social Security Administration (SSA) offices must
wear a face covering that covers their mouth and nose while in the SSA facility. (We will provide
a face covering to any visitor that arrives for an appointment without one.)
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NOTE: Exceptions to the face covering policy include visitors under 2 years old and
people who cannot wear one, generally for medical reasons. If the visitor individual
reports being unable to wear a face covering, management will make alternative service
plans.
Inform the individual that you will perform a screening with them now, but they will
need to review the posted signage when they arrive and complete the screening process
again before entering the building.
Inform the individual that they cannot enter the building if they have any of these
symptoms; cannot meet the screening criteria; or feel ill in any way.

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Continue with the screening for the individual and the person assisting the individual during the visit, if applicable.
Let the individual know that you will read a series of questions, and at the end, you will need to know if any, but not
which specific ones(s), apply to them.
Do you have any new or worsening symptoms of COVID-19 including:
o Fever (100.4 degrees or higher);
o Cough or sore throat;
o Shortness of breath or difficulty breathing;
o Fatigue;
o Muscle pain or body aches;
o Headache;
o New loss of taste or smell;
o Congestion or runny nose; or
o Nausea, vomiting, or diarrhea
Have you:
Within the last 10 days:
o Been diagnosed with COVID-19;
o Received instructions from a public health authority (local health authority, medical professional, etc.) to
self-monitor for symptoms of COVID-19 or self-quarantine due to COVID-19;
o Been tested for COVID-19 and are awaiting the results (other than for travel purposes); or
o Been in close physical contact with anyone who was diagnosed with COVID-19 or developed symptoms
consistent with COVID-19?
Close physical contact is defined as being within 6 feet of an infected/symptomatic person for a cumulative total of
15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic
individuals, 48 hours prior to test specimen collection).
Within the last 5 days:
o Traveled outside the country by means other than land travel, such as car, bus, ferry, or train?
IMPORTANT: Do not record or maintain responses to these questions. Individuals are not
required to provide details regarding their responses, and you may not ask for details.
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If the individual responds “Yes” to any of these questions, the manager may not
schedule the interview.

NOTE: It is imperative that we still provide service for individuals who have an
appointment, but are not able to proceed with their appointment due to having COVID-19
symptoms, or other outlined conditions. You must work with those individuals to ensure we
provide service in a safe and healthy manner.
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If the individual responds “No” to all of these questions, the manager will:
o Verify the individual’s contact information.
o Set up an appointment for the visit.
NOTE: Appointments must be staggered to comply with social distancing guidelines.
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Inform the individual to contact you to reschedule the appointment, or make
alternate arrangements for service, if they should experience any of the
symptoms you discussed or if they feel ill in any way