Daily Employee COVID-19 Symptom Screening Log

Date Employee Name Employee ID Department/Location Temperature (°F) Symptoms (check all that apply): Fever/chills Cough Shortness of breath Sore throat Loss of taste/smell Muscle aches Headache Other (specify below) Screening Result: Cleared for Work Not Cleared Screener Name

Date	Employee Name	Employee ID	Department/Location	Temperature (°F)	Symptoms	Screening Result	Screener Name