Title Page
-
Conducted by
-
Date & Time
-
Site & Entrance
Covid Temperature Check
- Employee Temperature
-
Employee Name
Employee Temperature
-
Warning: Over normal temperature
Temperature less than slight fever?
-
Employee has a fever. Send home immediately.
-
Has employee experienced any of the following symptoms?
- Dry cough
- Loss of taste
- Loss of smell
- Shortness of breath
- Chills
- Sore throat
- Fatigue
- Muscle pain
- Chest pain
- Nausea
- Vomiting
- Diarrhea
- Headaches
- Eye soreness
- Abdominal pain
- Blisters on feet
-
If employee has experienced at least 1 of the above symptoms, send home immediately.
-
Has employee experienced any of the following symptoms?
- Dry cough
- Loss of taste
- Loss of smell
- Shortness of breath
- Chills
- Sore throat
- Fatigue
- Muscle pain
- Chest pain
- Nausea
- Vomiting
- Diarrhea
- Headaches
- Eye soreness
- Abdominal pain
- Blisters on feet
-
If employee has experienced more than 1 of the above symptoms, send home immediately
After Covid Temperature Check
-
Date & Time Covid Temperature Check Ended
-
Signature of Person Who Conducted Covid Temperature Check
