Template

COVID-19 Return to Work Sign-In Form

20+

This return to work sign-in form helps organizations screen staff before re-entry to the workplace. It records employee and manager details, asks about COVID-19 symptoms, recent diagnosis, close contact and medical advice to self-isolate, and captures additional notes. Employees provide a signature to confirm declarations. Use as a guidance template and adapt to your policies and local regulations.

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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

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SafetyCulture

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

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+
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Template
School Staff COVID-19 Sign-In and Health Declaration
This School Staff COVID-19 sign-in and health declaration template helps schools screen staff before entry each day. It captures date, name, school and principal details, asks about symptoms, recent diagnosis, close contacts, self-isolation and high-risk status, and records sign-off to confirm fitness for work. Use it to support safe, compliant school operations and contact tracing.
by SafetyCulture
Downloads: 20+
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Template
COVID-19 Return to Work Record
Use this COVID-19 Return to Work Record to document employee details, absence history, and a safe return-to-work induction. Capture symptom checks, confirm PPE issued, brief staff on updated COVID-19 safety measures, and complete manager sign-off for HR compliance. This customizable template supports organizations in standardizing their return-to-work process, maintaining records for audits, and promoting a safe, compliant workplace during reopening and ongoing operations.
by Beth Reed, from the Community
Downloads: 200+
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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

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

School Staff COVID-19 Sign-In and Health Declaration

This School Staff COVID-19 sign-in and health declaration template helps schools screen staff before entry each day. It captures date, name, school and principal details, asks about symptoms, recent diagnosis, close contacts, self-isolation and high-risk status, and records sign-off to confirm fitness for work. Use it to support safe, compliant school operations and contact tracing.

by SafetyCulture

20+

Get

Template

COVID-19 Return to Work Record

Use this COVID-19 Return to Work Record to document employee details, absence history, and a safe return-to-work induction. Capture symptom checks, confirm PPE issued, brief staff on updated COVID-19 safety measures, and complete manager sign-off for HR compliance. This customizable template supports organizations in standardizing their return-to-work process, maintaining records for audits, and promoting a safe, compliant workplace during reopening and ongoing operations.

by Beth Reed, from the Community

200+

Get

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

60+

Get

COVID-19 Return to Work Sign-In Form

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Return to Work COVID-19 Health Declaration

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COVID-19 Return to Work Record

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Return to Work COVID-19 Health Declaration

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