Template

COVID-19 Employee Screening Questionnaire

200+

Use this COVID-19 employee screening questionnaire to assess staff before work. Capture project details, employee name, date, location, temperature results, and PPE status. Ask about recent exposure, self-quarantine orders, and key symptoms such as fever, cough, shortness of breath, sore throat, muscle aches, or loss of taste or smell. Includes guidance on next steps if any answer is yes and space for Health and Safety Officer and employee signatures. Intended as a starting template; seek professional advice for your workplace.

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

SafetyCulture

Free 1,000+ Workplace Checklists & Templates created by the SafetyCulture team.

Template
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+
Get
Template
COVID-19 Jobsite Visitor Questionnaire
This COVID-19 jobsite visitor questionnaire helps screen visitors before entering a worksite. It captures project and visitor details, date, reason for visit, health and safety officer, and location. The form asks about confirmed COVID-19 diagnosis, recent symptoms such as fever, cough, shortness of breath, sore throat, muscle aches, and loss of taste or smell, and recent exposure to confirmed or symptomatic cases, including recent travel exposure. It concludes with sign-offs from the health and safety officer and the visitor to document acknowledgement. Use this template to standardize screening and support safer site access control.
by SafetyCulture
Downloads: 80+
Get
Template
COVID-19 Symptoms Checklist
Use this COVID-19 symptoms checklist to screen students, staff, and families before entering school or work. The form lists common symptoms such as fever, cough, shortness of breath, chills, fatigue, muscle aches, headache, loss of taste or smell, sore throat, congestion, nausea, vomiting, and diarrhea, and includes exposure and quarantine questions. Follow the guidance to stay home, contact the school, or seek medical care when necessary.
by Lucid Film, from the Community
Downloads: 30+
Get
Template
COVID-19 Daily Health Screening Checklist
This daily COVID-19 screening checklist helps organizations assess employees, visitors, and clients before entry. It covers exposure questions, symptom checks for fever, cough, shortness of breath, sore throat, and muscle aches, and guidance on activating protocols, exclusion recommendations, and medical follow-up. The template reinforces infection control practices including distancing, face coverings, hand hygiene, and surface cleaning. For guidance only; verify requirements for your workplace and jurisdiction.
by SafetyCulture
Downloads: 90+
Get

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

60+

Get

Template

COVID-19 Jobsite Visitor Questionnaire

This COVID-19 jobsite visitor questionnaire helps screen visitors before entering a worksite. It captures project and visitor details, date, reason for visit, health and safety officer, and location. The form asks about confirmed COVID-19 diagnosis, recent symptoms such as fever, cough, shortness of breath, sore throat, muscle aches, and loss of taste or smell, and recent exposure to confirmed or symptomatic cases, including recent travel exposure. It concludes with sign-offs from the health and safety officer and the visitor to document acknowledgement. Use this template to standardize screening and support safer site access control.

by SafetyCulture

80+

Get

Template

COVID-19 Symptoms Checklist

Use this COVID-19 symptoms checklist to screen students, staff, and families before entering school or work. The form lists common symptoms such as fever, cough, shortness of breath, chills, fatigue, muscle aches, headache, loss of taste or smell, sore throat, congestion, nausea, vomiting, and diarrhea, and includes exposure and quarantine questions. Follow the guidance to stay home, contact the school, or seek medical care when necessary.

by Lucid Film, from the Community

30+

Get

COVID-19 Daily Health Screening Checklist

Template

COVID-19 Daily Health Screening Checklist

This daily COVID-19 screening checklist helps organizations assess employees, visitors, and clients before entry. It covers exposure questions, symptom checks for fever, cough, shortness of breath, sore throat, and muscle aches, and guidance on activating protocols, exclusion recommendations, and medical follow-up. The template reinforces infection control practices including distancing, face coverings, hand hygiene, and surface cleaning. For guidance only; verify requirements for your workplace and jurisdiction.

by SafetyCulture

90+

Get

COVID-19 Employee Screening Questionnaire

About author

You might also like

COVID-19 Employee Pre-Site Self Assessment

COVID-19 Jobsite Visitor Questionnaire

COVID-19 Symptoms Checklist

COVID-19 Daily Health Screening Checklist

You might also like

COVID-19 Employee Pre-Site Self Assessment

COVID-19 Jobsite Visitor Questionnaire

COVID-19 Symptoms Checklist

COVID-19 Daily Health Screening Checklist