Delivery Driver COVID-19 Access Screening Form
Driver Name
Delivery Company
Phone Number
Date
Time of Arrival
COVID-19 Screening Questions
1. Are you currently experiencing any COVID-19 symptoms (e.g., fever, cough, difficulty breathing, loss of taste or smell)?
Yes
No
2. Have you tested positive for COVID-19 in the past 14 days?
Yes
No
3. In the past 14 days, have you been in close contact with anyone confirmed or suspected to have COVID-19?
Yes
No
4. Have you traveled outside the country or been instructed to quarantine in the past 14 days?
Yes
No
Signature
Name / Signature