Protect staff and customers from COVID-19 exposure: COVID-19 Health Screening Form
What is a COVID-19 Health Screening Form?
This COVID-19 Health Screening Form is a document that individuals can fill out upon entering a business' premises to help protect the health and safety of the community. COVID-19 Screening Forms acts as a declaration of health contains questions regarding common symptoms of COVID-19 and ask individuals if them or their immediate family members have come in contact with a confirmed case of COVID-19. If your business is works with or employs individuals who are high risk for COVID-19, it is helpful to have this form on hand for guests to fill out.
If used properly, a COVID-19 Health Screening Form can help to prevent the spread of illness and support contact tracing in a business environment. When making a COVID-19 Health Screening Form, you will need to be sure that your business meets the state and local regulations for reopening and returning to work. Before you allow customers and employees back, it is important that you are following all local rules and regulations. ask an attorney if you are unsure about the guidelines that apply to your business.
When to use a COVID-19 Health Screening Form:
- You are a business owner who wants to ensure the safety of your staff and customers.
- You want to ensure the safety of your employees.
Have questions about your COVID-19 Health Screening Form?
Whether you're preparing your COVID-19 Health Screening Form, reviewing one someone sent you, or just want to understand it better, here's how to get help.
- Understand what it says or review it. Use our AI legal assistant to ask questions about your COVID-19 Health Screening Form, understand what it says, and spot anything that may need a closer look.
- Ask an attorney a question. Connect with an attorney for legal information, with a written answer within one business day or a live consultation.
- Get advice on what to do. For privileged, confidential advice about your specific circumstances and next steps, book a Legal Advice Session with an attorney.
Sample COVID-19 Health Screening Form
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of , , is monitoring the COVID-19 situation closely and following the directives of state and public health officials. To keep the health and safety of our community, you must fill out this declaration of health. This information will remain private and confidential unless it is necessary to contact trace any COVID-19 cases. Your information will not be used for any other purposes.
Full Name:
Phone Number:
Have you now, or in the past 72 hours, had any of the following symptoms?
| Fever | _____Yes | ____No |
| _____Yes | ____No |
| By: | Date: |
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___Sign this document. This document needs to be signed by:
This document is effective as of signing.
___Everyone gets a copy. You should keep a copy for your records.
