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Employee Feedback Survey Templates /
Covid Employee Screening Survey Template

Covid Employee Screening Survey Template

A short and essential survey for Covid Employee Screening before entering office premises.

Have you travelled outside of Canada in the last 14 days (circle answer)?

Yes
No

Has someone you are in close contact with tested positive for COVID-19 in the last 14 days?

Yes
No

Are you in close contact with a person who is sick with new respiratory symptoms or who recently traveled outside of Canada?

Yes
No

Do you have a fever?

Yes
No

Do you have any of these symptoms*

Yes
No

Are these symptoms typical for you (i.e. history of allergies, migraines, other known medical condition that usually causes these symptoms)?

YES (Please self-isolate. Contact your doctor for a note confirming that symptoms are typical before returning to work)
NO (Go home immediately and self-isolate. You may

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Email*

Any questions?

Name

Email

Company

Mobile

Message

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