COVID-19 Health Screening Form for Film Sets
Personal Information
Full Name
Role/Position
Date
Symptom Check
Fever or chills
Cough
Shortness of breath or difficulty breathing
Sore throat
Muscle or body aches
Loss of taste or smell
Headache
Nausea or vomiting
Diarrhea
Contact & Exposure
Have you been in close contact with anyone who tested positive for COVID-19 in the past 14 days?
Yes
No
Have you tested positive for COVID-19 in the past 10 days?
Yes
No
Temperature
Temperature (°F)
Additional Comments