Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Untitled Page

  • Date:

Screening Questions

  • First Name

  • Last Name

  • Check

  • Temperature

  • Cough

  • Circle either

Sore Throat

  • Circle either

  • New Shortness of Breath

  • Circle either

  • Asked to Go home

  • (If Yes to ANY)?

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.