Contactless health screen survey template + Sample questionnaire

Use the contactless health-screen survey template to know if your employees, visitors, and vendors are healthy and safe to visit the office premises. Know if they are free from COVID-19 symptoms and take actions early to secure their and co-workers' health.

This free contactless health-screen questionnaire is a ready-to-use resource for convention centers and essential services providers. You can always customize this as per your requirements.

Let your staff and visitors know if they are fit enough before they come to the workplace. Frame processes if they experience any unusual symptoms to take action early on.

Contactless health screen survey template + Sample questionnaire

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First Name Last Name Email Address Phone Number Department Have you, or anyone you have been in contact with, had a positive test or presumptive test for Covid-19 in the last 14 days? Yes No Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, or had a temperature that is elevated for you/100.0f or greater? Yes No Are you experiencing any of the following symptoms? (please check all that apply) Fever, chills or repeated shaking with chills Sore throat New cough (not related to chronic condition) Nasal congestion or runny nose (not related to seasonal allergies) Muscle aches New loss of taste or smell Shortness of breath or chest tightness (that is new/unusual to you) No symptoms