Use this covid sign-in sheet template for daily COVID-19 screening and sign-in for employees and visitors. With this screening and sign-in sheet template on a mobile device, you can limit the sharing and touching of paper-based writing materials between multiple employees and visitors. This template was created based on https://www.seattleschools.org/UserFiles/Servers/Server_543/File/District/Departments/Human%20Resources/COVID%20Docs/Covid%20Building%20Entry%20Sign_05212020%20JSCEE.pdf
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Title Page
Conducted on
Prepared by
Location
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
SafetyCulture Staff
Covid Sign-in Sheet Template
Use this covid sign-in sheet template for daily COVID-19 screening and sign-in for employees and visitors. With this screening and sign-in sheet template on a mobile device, you can limit the sharing and touching of paper-based writing materials between multiple employees and visitors. This template was created based on https://www.seattleschools.org/UserFiles/Servers/Server_543/File/District/Departments/Human%20Resources/COVID%20Docs/Covid%20Building%20Entry%20Sign_05212020%20JSCEE.pdf
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.
