COVID-19 Health Clearance Form for Construction Sites
Personal Details
Full Name
Employee/ID Number
Construction Site/Project
Date
Health Screening
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Exposure History
Have you been in close contact with anyone confirmed or suspected to have COVID-19 in the past 14 days?
Yes
No
Travel History
Have you traveled internationally or to high-risk areas in the last 14 days?
Yes
No
I confirm that to the best of my knowledge the information given is correct.
Signature
Date