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  • Conducted on

  • Prepared by

  • Location


  • Have you or anyone in your residence traveled internationally within the past 14 days?

  • Have you monitored your health today?

  • Do you feel healthy?

  • Have you had a fever or known COVID symptoms such as: fever, compromised breathing, no taste/smell?

  • Have you been tested for COVID and waiting the results?

  • Have you been in close contact with anyone who has tested positive or is waiting the results of COVID testing? (within 6ft for 15 minutes)


  • Is anyone on site who is exhibiting symptoms of illness / COVID 19?

  • If yes, have they been removed from site?

  • Is anyone on site who has reported they have been tested for COVID and waiting results?

  • If yes, have they been removed from site?


  • Do you have PPE on site needed to reduce exposure to COVID? (Porta Potty's / Handwashing Stations)

  • Are the COVID postings on site?

  • Are the trades using COVID PPE?

  • Are the trades able to social distance (6ft)?

  • Are the tradespeople on site able to follow the current CDC recommendations?

  • Are non-essential visitors refused entry?


  • Contractors on site?

  • Job Sites you have traveled to today?

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