Juice Bar Employee Daily Health Screening
Employee Name
Date
Shift
Morning
Afternoon
Evening
1. Do you have any of the following symptoms: fever, cough, sore throat, shortness of breath, or loss of taste/smell?
No
Yes
2. In the past 24 hours, have you had a temperature above 100.4°F (38°C)?
No
Yes
3. Have you been in close contact with anyone confirmed or suspected to have COVID-19 in the past 14 days?
No
Yes
Notes/Comments