Employee Symptom Checklist
Employee Name
Date
Project/Job Site
Symptoms Checklist
Symptom
Yes
No
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
Other Symptoms or Comments
Employee Signature
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