Inspection

Personal Health & Hygiene

Do you have any flu symptoms such as headaches, running nose, sore throat, cough or fever?

Has anyone in your home travelled overseas in the past two weeks?

Do you have hand sanitizer and hand soap on hand?

Have you been in contact with anyone currently carrying COVI-19

Is anyone else in your household self isolating?

Have you been in contact with anyone currently self isolating?

Underlying Conditions

Are you 70 or over?

Do you suffer from any of the following?

If any of the above is selected, then person should self isolate.

Are you pregnant?

Do you suffer from any of the following?

Please write in here any other condition that may be relevant?

If any of the above have been selected, then social distancing is recommended

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.