Template

Highline Mushrooms COVID-19 Employee Screening

by Shawn Chadwick, from the Community

This COVID-19 employee screening questionnaire is used at Highline Mushrooms to assess associates, visitors, and contractors upon arrival. The form captures site and employee details, temperature scan results, mask compliance, and key screening questions covering recent exposure, quarantine directives, travel outside Canada, and COVID-19 symptoms. If any response indicates risk, the screener activates Highline’s emergency protocol: verify results, instruct the individual to go home and contact their physician, and notify management or HR. The checklist concludes with signatures from the monitoring associate and the employee to confirm review and compliance.

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Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
COVID-19 Employee Screening Questionnaire
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Downloads: 200+
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This COVID-19 occupant health checklist helps contractors and field teams screen household or building occupants before a site visit. It prompts for recent travel and exposure, common COVID-19 symptoms, and confirms whether the environment is safe for workers to enter. The form can capture a phone number and signature for contact tracing, aligns with public health guidance, and references compliance with privacy regulations such as Canada’s PIPA. Use it as part of a construction or service provider health and safety program to standardize screening and reduce transmission risk.
by emre Dagseven, from the Community
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COVID-19 Employee Temperature Screening Checklist
This COVID-19 employee temperature screening checklist helps facility and security teams screen workers at entry points. Record temperatures, check for fever, cough, or shortness of breath, and determine access based on results. Includes guidance for when thermometers are unavailable, reminders on hand hygiene and distancing, and steps to restrict entry and notify supervisors if symptoms or fever are present. Intended to reduce workplace transmission risk and provide a consistent screening process. Not a substitute for medical advice or treatment.
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COVID-19 Employee Pre-Site Self Assessment
This COVID-19 employee pre-site self assessment helps screen staff before attending a worksite. It asks about close contact with COVID-19 cases, medical direction to self-quarantine, recent symptoms such as fever, cough, shortness of breath, sore throat, muscle aches, or loss of taste or smell, and overall wellness. Clear guidance advises employees who answer Yes to stay home, notify their line manager per the handbook, and book a test if symptoms are COVID-19 related. The form captures date and signature for recordkeeping.
by Philip Davison, from the Community
Downloads: 60+
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Highline Mushrooms COVID-19 Employee Screening

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