Kitchen Staff Health Declaration Form
Full Name
Position
Date
Health Screening
Do you have any of the following symptoms?
Fever
Cough
Sore Throat
Nausea/Vomiting
Diarrhea
None of the above
Have you been diagnosed with or been in contact with any infectious diseases in the past 14 days?
No
Yes
Any cuts, wounds, or skin infections on hands or arms?
No
Yes
Additional Comments
I declare that the above information is true and accurate to the best of my knowledge.
Signature