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Daily Sign-in Sheet

  • By signing below, I confirm that the following statement is true and correct to the best of my knowledge:
    Since my last day of work, or last visit here, I confirm that I have not had the following symptoms:
    • Cough
    • Shortness of breath or difficulty breathing
    OR, Two or more of the following symptoms:
    • Fever
    • Chills
    • Repeated shaking with chills
    • Muscle Pain
    • Headache
    • Sore throat
    • New loss of taste or smell
    I understand that if I have had coughing; or shortness of breath; or difficulty breathing; or two or more of the
    listed symptoms since my last day of work or visit here, I must not enter the building.

  • Sign-in
  • Time of Entry

  • Purpose

  • Contact #

  • Name and Signature

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.