COVID-19 Employee Health Screening Form for Onsite Screening: Fill out & sign online

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Click ‘Get Form’ to open the COVID-19 Employee Health Screening Form in our editor.
Begin by entering the 'Employer Name' and the 'Person Completing Form' at the top of the document.
Fill in the 'Date' field to indicate when the screening is taking place.
For each employee, review the symptoms listed. Circle 'Y' for yes or 'N' for no next to each symptom, including cough, shortness of breath, fever, and any other symptoms.
If an employee reports any symptoms, follow the outlined steps: send them home immediately and ensure increased cleaning measures are taken.
Record the temperature if taken and describe any other symptoms in the designated area.
Once completed, save your form securely within our platform for three months as required.

Start using our platform today to streamline your COVID-19 Employee Health Screening process for free!

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Versions	Form popularity	Fillable & printable
2020	4.1 Satisfied (58 Votes)
2013	4.7 Satisfied (27 Votes)

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What is an onsite health screening?

An onsite health screening appointment typically lasts 10 minutes from beginning to end. Biometrics such as height, weight, blood pressure, cholesterol, and glucose (blood sugar) are measured.

What should an employee do if they test positive for COVID?

Workers should stay home unless they need medical care. Employers must provide at least 5 days or 40 hours of paid sick leave per year to their employees in California. Provide workers with information on how they can request and use paid sick leave benefits.

What is an employee health screening?

Do you feel feverish or have a fever (greater than 100.4F / 38C)? Do you have a cough? Do you feel short of breath or are you having trouble breathing? Have you been in contact with someone who has tested positive for Coronavirus, has COVID-19 or is being evaluated for Coronavirus (person under investigation)?

What do they do during a health screening?

Annual Physical Examination Blood tests to check blood sugar and cholesterol levels. Immunizations, such as the flu shot. Pelvic exam (women) Weight, blood pressure, and temperature check. Screening questions about depression, smoking, and alcohol use.