Screening Checklist for Visitors and Employees
Following questions will be asked all individuals entering the building.
Name of the Individual
1. Has the individual washed his/her hands or used antiseptic?
Yes
No (please ask her/him to do)
2. Which of the following symptoms does the individual have?
Fever
Cough
Shortness of Breath
Persistent Pain in the Chest
❗Restrict the individual from entering the building!
3. For employees - check the temperature and enter the result.
4. Has the individual contacted with people that were infected, suspected or diagnosed with COVID-19?
Yes
No
5. Additional Notes
❗Restrict the individual from entering the building!
Remind and ask individuals to:
Wash their hands or use antiseptics
Not shake hands or contact physically
Wear facemasks in the building
Submit
Should be Empty: