Employee Covid 19 Daily Check

• Conducted on

  Date

• Prepared by

• How do you feel?

  Well

  Unwell

  N/A
Temperature Reading

• PLEASE DO NOT PROCEED INTO THE WORKPLACE AND SELF ISOLATE IMMEDIATELY IN THE PRE DETERMINED SELF ISOLATION ROOM.

• As the Coronavirus Disease (COVID-19) outbreak continues to evolve, we are conducting a simple daily screening questionnaire in order to reduce any potential risk of exposure to our employees, customers and visitors.

Now or in the last 14 days, please confirm you or a cohabitant or a close family member have not;

• Visited any countries outside of Ireland excluding Northern Ireland.

• Had any flu like symptoms/symptoms of COVID-19 (fever, cough, difficulty breathing)

• Been in contact with or near (less than 2 meters for more than 15 minutes in 1 cumulative
  day) anyone who is now diagnosed to have COVID-19 (Coronavirus)

• Been advised by a Doctor to self-isolate or cocoon

• Been in a hospital, care facility, work environment, which has experienced a known outbreak of COVID-19 in the past 14 days.

• Did you answer ‘ YES ‘ to any of the above questions?

  Yes

  No

• PLEASE DO NOT PROCEED INTO THE WORKPLACE AND SELF ISOLATE IMMEDIATELY IN THE PRE DETERMINED SELF ISOLATION ROOM.