Screening

This checklist is derived from https://www.tuolumnecounty.ca.gov/DocumentCenter/View/14186/COVID-19-Employee-Screening-Form

If a person is being sent home, they must inform their supervisor and/or Human Resources that they were sent home and is responsible for following-up with their primary care physician if needed.

1. Have you washed your hands or used alcohol-based hand sanitizer on entry?

Please ask them to do so

2. Do you have any of the following respiratory symptoms?

If YES to any, restrict them from entering the building and send person home.

If NO to all, proceed to remaining questions

3. Employee’s temperature:

If you do not have a thermometer to take their temperature, go to step #3B.

3A. Does the employee have a fever (temperature 100.4°F or greater)

If YES, restrict them from entering the building and send person home.

If NO, proceed to question #3C.

3B. Ask the employee the following:

Are you feeling feverish?

If YES to any, restrict them from entering the building and send person home.

Are you having chills?

If YES to any, restrict them from entering the building and send person home.

If NO, proceed to question 3C.

3C. Ask the employee the following:

1. Have you worked in facilities with confirmed COVID-19 cases?

If YES, ask question #2 below.

2. Have you worked with persons with confirmed COVID-19 by lab test?

If YES to any, restrict them from entering the building and send person home.

If NO, proceed to step #4.

If NO, proceed to step #4.

4. Allow entry to building and remind individual to:

Wash their hands or use alcohol-based hand sanitizer throughout their time in the building.

Not to shake hands with, touch, or hug others during their time in the building.

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.