COVID-19 Daily Health Self-Assessment Questionnaire for Employees
The following questionnaire is for California. Find other available locations below.
California
Total of 16 Questions
- 1. Have you had any of the following COVID-19 symptoms since your last day at work or the last time you were here?
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1.1 Cough?
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1.2 Shortness of breath or difficulty breathing?
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1.3 Fever or Chills?
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1.4 Headache?
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1.5 Muscle or body aches?
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1.6 Sore throat?
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1.7 New loss of taste or smell?
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1.8 Fatigue?
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1.9 Congestion or runny nose?
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1.10 Nausea or vomiting?
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1.11 Diarrhea?
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1.12 Persistent pain or pressure in chest?
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1.13 New confusion?
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1.14 Inability to wake or stay awake?
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1.15 Bluish lips or face?
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2. Besides to and from work, have you traveled to the states that are subjected to self-quarantine within the last two weeks?
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3. If Yes to Question 2: Which state have you been?
Keep your Workers Safe & Stop the Spread
Many U.S. states and Canadian provinces require employees to self-certify they are not exhibiting COVID-19 symptoms creating quite the headache for HR and Safety departments forced to collect and store these back to work health assessments.
Preworkscreen’s employee COVID-19 screening app is a paperless, quick, easy, and safe way for employees to report their health status to their employer. Get started now and let Preworkscreen handle all the COVID-19 issues your HR & Safety departments are encountering.
Keep your Workers Safe & Stop the Spread
Many U.S. states and Canadian provinces require employees to self-certify they are not exhibiting COVID-19 symptoms creating quite the headache for HR and Safety departments forced to collect and store these back to work health assessments.
Preworkscreen’s employee COVID-19 screening app is a paperless, quick, easy, and safe way for employees to report their health status to their employer. Get started now and let Preworkscreen handle all the COVID-19 issues your HR & Safety departments are encountering.
Keep your Workers Safe & Stop the Spread
Many U.S. states and Canadian provinces require employees to self-certify they are not exhibiting COVID-19 symptoms creating quite the headache for HR and Safety departments forced to collect and store these back to work health assessments.
Preworkscreen’s employee COVID-19 screening app is a paperless, quick, easy, and safe way for employees to report their health status to their employer. Get started now and let Preworkscreen handle all the COVID-19 issues your HR & Safety departments are encountering.
The Most Popular COVID-19 Screening App for Employees
Organizations from small businesses to public companies in all 50 U.S. states and Canadian provinces are using Preworkscreen since May 29, 2020, including manufacturing, healthcare, BFSI, office, school, transportation, agriculture, hotel, construction, and other industries.
No matter what kind of work you do, Preworkscreen's unmatched functionalities will help you implement COVID-19 work safety in the most efficient way possible.