Printable Covid 19 Screening Questionnaire

Printable Covid 19 Screening Questionnaire – This template was developed from the university of michigan university health service and the us center for diseases and control. If you have experienced any of the following symptoms in the past 48 hours, you should not access. This document provides examples for workplaces and establishments to use if they implement covid.

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Printable Covid 19 Screening Questionnaire

Adapted for use on february 28, 2020. Name:________________________________ date:________________________ please circle the appropriate responses. Ad questionnaire to help you understand your covid risk status & options.

Fever Or Chills • New Or Unexplained Onset Of Cough, Shortness Of Breath, Or.

For Vaccine Recipients (Both Children And Adults):

I certify that all answers are true and correct to the best of my knowledge. Certification hereby certify that the responses provided above are true and accurate to the best of my knowledge. Maintaining an “employee only” entrance to perform screening.

There Are Many Ways To Communicate And Implement An Employee Screening Process.

Questions asked at initial screening: Please complete this form before entering cdc buildings. Have you experienced any of the symptoms in the list below in the past 48 hours1?

COVID19 Screening Questionnaire Support