COVID-19 Construction Site Worker Screening Form
Date:
Worker Name:
Company:
Temperature (°C):
Screening Questions
Do you have any of the following symptoms: cough, shortness of breath, fever, chills, fatigue, new loss of taste or smell?
Yes
No
Have you been in close contact with a confirmed or probable case of COVID-19 in the past 14 days?
Yes
No
Have you traveled internationally within the last 14 days?
Yes
No
Worker Signature: