Template

COVID-19: Screening Checklist for Visitors and Employees

by Zhang Pingan, from the Community

60+

Use this COVID-19 screening checklist to triage visitors and employees before entry to healthcare and assisted living facilities. Based on CMS and CDC guidance, it covers symptom questions (fever, sore throat, cough, shortness of breath), temperature checks for staff, exposure screening, and entry restrictions. It reinforces hand hygiene, masking for compassionate visits, and limiting movement to designated areas. Intended as a general template to support infection control; not a substitute for medical advice, diagnosis, or treatment.

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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

Community

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 Screening Checklist for Visitors and Staff
This COVID-19 screening checklist helps healthcare and assisted living facilities assess visitors and employees for symptoms and exposure before entry. It follows CMS and CDC guidance for restricting non-essential personnel and includes prompts for hand hygiene, symptom checks (fever, sore throat, cough, shortness of breath), temperature screening for employees, exposure history, and entry restrictions. It also reminds permitted visitors to wear a facemask and limit movement within the facility. The checklist is informational and not a substitute for medical advice, diagnosis, or treatment.
by Sheila Layo, from the Community
Downloads: 0
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Template
COVID-19 Screening Checklist for Visitors and Employees
This COVID-19 screening checklist helps healthcare and assisted living facilities screen visitors and employees for symptoms and potential exposure before entry. It follows early CMS and CDC guidance for restricting non-essential visits to skilled nursing facilities and includes prompts for hand hygiene, symptom checks, temperature checks for staff, and requirements for permitted visitors. Use it to support infection control and safer operations. This resource provides general information only and is not a substitute for medical advice, diagnosis, or treatment.
by SafetyCulture
Downloads: 3,000+
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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+
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Template
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.
by SafetyCulture
Downloads: 2,000+
Get

COVID-19 Screening Checklist for Visitors and Staff

This COVID-19 screening checklist helps healthcare and assisted living facilities assess visitors and employees for symptoms and exposure before entry. It follows CMS and CDC guidance for restricting non-essential personnel and includes prompts for hand hygiene, symptom checks (fever, sore throat, cough, shortness of breath), temperature screening for employees, exposure history, and entry restrictions. It also reminds permitted visitors to wear a facemask and limit movement within the facility. The checklist is informational and not a substitute for medical advice, diagnosis, or treatment.

by Sheila Layo, from the Community

Get

Template

COVID-19 Screening Checklist for Visitors and Employees

This COVID-19 screening checklist helps healthcare and assisted living facilities screen visitors and employees for symptoms and potential exposure before entry. It follows early CMS and CDC guidance for restricting non-essential visits to skilled nursing facilities and includes prompts for hand hygiene, symptom checks, temperature checks for staff, and requirements for permitted visitors. Use it to support infection control and safer operations. This resource provides general information only and is not a substitute for medical advice, diagnosis, or treatment.

by SafetyCulture

3,000+

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

90+

Get

Template

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.

by SafetyCulture

2,000+

Get

COVID-19: Screening Checklist for Visitors and Employees

About author

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