Template

COVID-19 Self-Declaration Form

by M Gibbs, from the Community

100+

Use this COVID-19 self-declaration checklist to assess staff, contractors, and visitors for potential exposure and symptoms prior to entering a site or appointment. Record personal details, travel history or contact exposure, symptom checks, and temperature readings. Reinforce hygiene, PPE use, and social distancing practices to reduce transmission risk. Ideal for workplaces seeking a simple, consistent screening process during outbreaks.

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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

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

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 Temperature Check Log
Use this COVID-19 temperature check log to document daily screenings for staff, visitors, and drivers. Capture the date and time of screening, body temperature readings, names, and signatures, along with preparer details and acknowledgements. This simple record helps organizations maintain compliance with infection control policies and supports contact tracing protocols. Suitable for workplaces, clinics, and facilities that require routine health screening during outbreaks and beyond.
by June Cheng, from the Community
Downloads: 60+
Get
Template
COVID-19 Compliance Audit
Use this COVID-19 compliance audit to evaluate workplace readiness and adherence to health protocols. The checklist covers site setup and recordkeeping, entrance postings, response plans, worker and visitor registers with contact details, temperature screening, sanitation and handwashing facilities, adequate waste bins, correct PPE use, and social distancing practices. Ideal for construction and other onsite operations seeking to standardize COVID-19 safety checks and document audit certification.
by Cindy Kyle, from the Community
Downloads: 200+
Get
Template
Return to Work COVID-19 Health Declaration
This return to work COVID-19 health declaration helps organizations screen employees and contractors before reentry to the workplace. The form captures recent symptoms, diagnosis, close contacts, travel history, and at risk factors, and directs workers to contact supervisors or HR when needed. It outlines self isolation and restricted movement guidance, identifies high risk groups, and includes sign off to confirm accurate information for a safer return.
by Declan Dixon, from the Community
Downloads: 40+
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
Downloads: 3,000+
Get

COVID-19 Temperature Check Log

Use this COVID-19 temperature check log to document daily screenings for staff, visitors, and drivers. Capture the date and time of screening, body temperature readings, names, and signatures, along with preparer details and acknowledgements. This simple record helps organizations maintain compliance with infection control policies and supports contact tracing protocols. Suitable for workplaces, clinics, and facilities that require routine health screening during outbreaks and beyond.

by June Cheng, from the Community

60+

Get

Template

COVID-19 Compliance Audit

Use this COVID-19 compliance audit to evaluate workplace readiness and adherence to health protocols. The checklist covers site setup and recordkeeping, entrance postings, response plans, worker and visitor registers with contact details, temperature screening, sanitation and handwashing facilities, adequate waste bins, correct PPE use, and social distancing practices. Ideal for construction and other onsite operations seeking to standardize COVID-19 safety checks and document audit certification.

by Cindy Kyle, from the Community

200+

Get

Template

Return to Work COVID-19 Health Declaration

This return to work COVID-19 health declaration helps organizations screen employees and contractors before reentry to the workplace. The form captures recent symptoms, diagnosis, close contacts, travel history, and at risk factors, and directs workers to contact supervisors or HR when needed. It outlines self isolation and restricted movement guidance, identifies high risk groups, and includes sign off to confirm accurate information for a safer return.

by Declan Dixon, from the Community

40+

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

COVID-19 Self-Declaration Form

About author

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COVID-19 Temperature Check Log

COVID-19 Compliance Audit

Return to Work COVID-19 Health Declaration

COVID-19 Screening Checklist for Visitors and Employees

You might also like

COVID-19 Temperature Check Log

COVID-19 Compliance Audit

Return to Work COVID-19 Health Declaration

COVID-19 Screening Checklist for Visitors and Employees