Employee COVID-19 Daily Health Declaration
Full Name
Employee ID
Department
Date
Health Screening Questions
1. Do you have a fever or chills?
Yes
No
2. Do you have a cough or sore throat?
Yes
No
3. Have you experienced difficulty breathing?
Yes
No
4. Have you had contact with a confirmed COVID-19 case in the past 14 days?
Yes
No
I declare that the above information is accurate and complete to the best of my knowledge.