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 Mitti 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 Mitti 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

Mitti

Mitti (by SafetyCulture) is the operations system for every site, shift and standard. Trusted by 80,000 organizations in 190 countries, Mitti publishes free checklists, SOP templates, audit checklists and toolbox talk topics that turn paper processes into a digital audit trail. Download one, put it to work on your next inspection or shift, and see why teams keep coming back for more.

Template

COVID-19 Employee Pre-Site Self Assessment

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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.

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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.

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COVID-19 Employee Temperature Screening Checklist

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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.

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COVID-19 Daily Health Screening Checklist

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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.

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COVID-19 Prevention Screening Checklist

This COVID-19 prevention screening checklist helps teams record key details during entry screening, including name, date, temperature, and symptom checks for cough, sore throat, and shortness of breath. It supports clear go home decisions when any symptoms are present and promotes consistent infection control across worksites. Created as a starting point only, confirm suitability for your site and local requirements.

by cody taylor, from the Community

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COVID-19 Employee Screening Questionnaire

About author

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