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  • Conducted on

  • Prepared by

  • For more health and wellness practices, follow the CDC's Checklist for Individuals and Families @
    https://www.cdc.gov/coronavirus/2019-ncov/community/home/checklist-household-ready.html

Plan and Prepare

  • Within the last 14 days have you or anyone in your household had close contact with someone that is in the process of being tested or has tested positive for COVID-19?

  • Within the last 14 days have you or anyone in your household experienced any of the following: Fever or Flu-like symptoms; Cough; Trouble Breathing; Shortness of Breath; Chills; Repeated Shaking with Chills; Muscle Pain; Headache; Sore Throat; or New Loss of Taste or Smell?

  • Within the last 14 days have you or anyone in your household traveled outside the US or to any area with a known COVID-19 outbreak?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.