This COVID-19 safety assessment template helps teams evaluate risk through simple screening questions. It covers recent symptoms, essential worker status, social distancing at work, employer safety protocols such as handwashing and temperature checks, recent domestic or international travel, medical field exposure, contact with confirmed cases, adherence to shutdown or quarantine guidance, and personal sanitation habits. It also captures preferences about continuing a cleaning schedule and use of masks and gloves when entering a home. This is an example testing template and is not a substitute for professional advice.
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