Employee Covid-19 Screening

This Covid-19 screening questionnaire is designed for businesses and workplaces to conduct daily/weekly health screening checks. Use collective and individual screening forms to ensure that employees present no Covid-19 infection symptoms, and if so that they are able to get tested and self-isolate in a timely manner.​

Employee Covid-19 Screening



Daily Staff Health Checks

1. Are employees checked or self-assessing for COVID-19 symptoms daily? Symptoms of coronavirus. The main symptoms to look out for are: • A cough • A high temperature • A shortness of breath


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2. Management fully aware of procedures to follow in the event of staff illness?


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3. Have any employees reported or shown any signs of sickness?


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4. Was the employee(s) quarantined immediately?


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5. Was the employee(s) sent home?


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6. Did the employee(s) have any contact with fellow employees or customers? Describe contact in detail


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7. Return to work sickness forms / questionnaires consistently completed


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Individual Screening

1. Site Location


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3. Employee's full name


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4. Employee's phone number (best way to reach)


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5. Have you been in contact with anyone who has been experiencing the following symptoms? 1. Cough 2. High temperature 3. Shortness of breath


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6. Possible exposure details


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7. Did you recently travel?


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8. Are you currently experienced any of these symptoms?


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9. Will you be getting a test for Coronavirus / Covid-19?


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10. Report to Senior Management


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11. Signature


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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