Employee Covid Screening Questionnaires

When the coronavirus pandemic began, every organization was figuring out how to resume operations. To ensure safety at the workplace, many organizations have developed a variety of innovative approaches such as using apps or using questionnaire checklists to resist the spread of COVID-19. Below is the list of links on the various solutions developed by the organizations for the identification or screening of suspect COVID-19 victims. Please visit this page for regular updates.

 

Employee Covid Screening Questions

Wilson Sonsini Goodrich & Rosati (WSGR)

https://www.wsgr.com/images/content/2/6/26191/COVID-19-Health-Screening-Questionnaire.pdf

LeadingAge

https://leadingage.org/sites/default/files/Natl%20Church%20Residences%20Screening%20Questionnaire.pdf

Ontario Ministry of Health

http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/workplace_screening_tool_guidance.pdf

South Nevada Health District (SNHD)

https://media.southernnevadahealthdistrict.org/download/COVID-19/reopening/snhd-reopening-covid19-screening-questionnaire.pdf

King County

https://www.kingcounty.gov/depts/health/covid-19/workplaces/~/media/depts/health/communicable-diseases/documents/C19/employee-screening-tool.ashx

Mount Sinai

https://www.mountsinai.org/files/MSHealth/Assets/HS/Care/Occupational-Health/Front-Door-screening.pdf

CDC

https://www.cdc.gov/screening/paper-version.pdf

Tanner Health System

https://www.tanner.org/patients-and-visitors/patient-services/coronavirus/covid-19-screening-questionnaire

SpaceIQ

https://spaceiq.com/blog/covid-19-workplace-questionnaire/

Fisher Phillips

https://www.fisherphillips.com/assets/htmldocuments/COVID-19%20Sample%20Employee%20Questionnaire%20.pdf

American Dental Hygiene Association (ADHA)

https://www.adha.org/resources-docs/ADHA_TaskForceReport_Questionaire.pdf

SAFCEC

https://cdn.ymaws.com/www.safcec.org.za/resource/collection/56B6B69F-BE6F-4913-B126-7385D40BA123/04-COVID-19_Employee_Screening_Questionnaire_G.pdf

NSW Government

https://www.health.nsw.gov.au/Infectious/Forms/novel-coronavirus-case-questionnaire.pdf

Enhance Centre

https://sa1s3.patientpop.com/assets/docs/155226.pdf

EMC Canada

https://www.emccanada.org/uploads/userfiles/files/COVID-19%20Questionnnaire%20Template%20Responses(1).pdf

WHO

https://www.who.int/bulletin/online_first/20-255893.pdf

California Restaurant association

https://www.calrest.org/sites/main/files/file-attachments/covid-19_sample_employee_questionnaire_restaurants.pdf

Mckinsey and Company

https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/Organization/Our%20Insights/COVID%2019%20and%20the%20employee%20experience%20How%20leaders%20can%20seize%20the%20moment/COVID-19-and-the-employee-experience-How-leaders-can-seize-the-moment.pdf?shouldIndex=false

Food and Agriculture Organization

http://www.fao.org/fileadmin/user_upload/faoweb/FI/COVID19/Surveys_and_questionnairesCOVID.pdf

SHRM

https://www.shrm.org/resourcesandtools/tools-and-samples/hr-forms/pages/coronavirus-covid-19-employee-return-to-work-survey.aspx

Failte Ireland

https://covid19.failteireland.ie/wp-content/uploads/2020/05/May27Covid-19-Pre-return-to-Work-Form.pdf

TinyPulse

https://www.tinypulse.com/blog/employee-survey-questions-return-to-work-post-covid-19

TimeRack

https://www.timerack.com/time-and-attendance-solutions-blog/employee-covid-19-questionnaire-template

SmithAmundsen

https://www.salawus.com/assets/htmldocuments/COVID-19%20Questionnaire%20–%2010.29.2020.pdf

SurveyMonkey

https://www.surveymonkey.com/r/W66W7KN

WorkplaceNL

https://workplacenl.ca/site/uploads/2020/06/COVID-19-Guidelines-for-Employers.pdf

Australian HR Institute (AHRI)

https://www.ahri.com.au/media/4697/ahri_wellbeingsurvey_interactive.pdf

EOHU

https://eohu.ca/files/resources/12139-icd-20e.pdf?95f7fdc484

HDFC Life

https://brandsite-static.hdfclife.com/media/documents/apps/COVID-19%20Questionnaire.pdf

University of Notre Dame

https://uhs.nd.edu/assets/361448/screening_for_possible_covid19_provider_questionnaire.pdf

New Jersey Dept. of Education

https://www.nj.gov/education/students/safety/health/services/HealthHistoryUpdatedQuestionnaire_6-12-20.pdf

Siteforms

https://siteforms.ie/covid-19-screening-questionnaire/

Rhodes University

https://www.ru.ac.za/media/rhodesuniversity/content/cvrtt/documents/COVID-19_Daily_Self_Assessment_Screening_Questions.pdf

Atlantic Pediatric Dentistry

http://www.atlanticpediatricdentistry.com/assets/pdf/COVID-questionnaire.pdf

Montreal Kids Dentist

https://www.montrealkidsdentist.com/files/2020/05/Covid-19-Consent-Form-English-1-1.pdf

University of Iowa

https://www.lib.uiowa.edu/studio/covid-19-questionnaire/

Kyushu

https://www.kyushu-u.ac.jp/f/38232/Corona0302EN.pdf

Yonkers public school

https://www.yonkerspublicschools.org/site/handlers/filedownload.ashx?moduleinstanceid=134630&dataid=76329&FileName=STUDENT-COVID19-Fillin-Form.pdf

Atterbury Muscatatuck

https://www.atterburymuscatatuck.in.ng.mil/Portals/35/Camp%20Atterbury/Q-2%20Appendix%202%20(COVIND-19%20Screening%20Questionnaire).pdf?ver=2020-03-19-115707-367

Riverdock dental family

https://riverrockdentalfamily.com/wp-content/uploads/2020/04/COVID-19-questionnaire.pdf

Dukechiropractic

https://www.dukechironyc.com/assets/pdf/Covid-19-Patient-Questionnaire.pdf

Plexsys

https://www.plexsys.com/wp-content/uploads/2020/03/COVID-19-questionnaire-2020.pdf

Supplemental Health Questionnaire

https://assets-prod-www1.aaoinfo.org/assets-prod-www1/2020/05/Health-Questionnaire2-COVID19-fillable-clear-frame-sec.pdf

Washoe county

https://www.washoecounty.us/health/files/COVID19/All_Emp_COVID-19_Screening_Questionnaire.pdf

Empire Life

https://www.empire.ca/sites/default/files/2020-05/Covid-19-ClientQaire-EN-web.pdf

Swimming South Africa

http://swimsa.org/about/correspondence/general-news/screening-questionnaire/view

Buy and Sell

https://buyandsell.gc.ca/cds/public/2020/07/03/71b91eff038886902238fe60d27d9ebb/en_self-assessment_questionnaire_covid-19.pdf

USC

https://coronavirus.usc.edu/wp-content/uploads/2020/07/Coronavirus-Screening-Questionnaire_Visitor11.pdf

Wintershall Dea

https://wintershalldea.com/sites/default/files/media/files/COVID-19_Questionnaire%20for%20Visitors_20201007.pdf

VRCA

https://www.vrca.ca/wp-content/uploads/APPENDIX-M-Health-Questionnaire-Coronavirus-COVID-19.pdf

University of Toronto

https://medicine.utoronto.ca/sites/default/files/covid_19_screening_questionnaire_pt.pdf

Athletics Ireland

https://www.athleticsireland.ie/downloads/other/AAI_Club_Covid_questionnaire_050620.pdf

Hushmail

https://www.hushmail.com/secure-forms/templates/healthcare/3fb410018a8ee6f59270b5b489de17d8-covid-19-screening-questionnaire/

Papersurvey

https://www.papersurvey.io/templates/current-events/adult-coronavirus-covid-10-screening-questionnaire

DriverCheck

https://www.drivercheck.ca/covid19-screening-questionnaire

National Board of Economic Defense (NBED)

https://www.nbed.nb.ca/ParentPortal/Content/Covid-19/Screening%20Questionnaire%20for%20COVID-19.pdf

Illinois Department of Public Health (IDPH)

https://www.birches.net/uploads/images/IDPH-LTC_Visitor-Screening_030520.pdf

Cycling Ireland

http://www.cyclingireland.ie/downloads/covid19%20protocol%20-%20self-assessment%20personal%20screening%20questionnaire.pdf

Newport news public schools

http://sbo.nn.k12.va.us/returntolearn/healthscreening.html

Edmonton Catholic school

https://www.ecsd.net/page/8503/daily-health-screening-questionnaire

Valley county health system

https://www.valleycountyhealthsystem.org/covid-screen

Versum

https://www.versum.com/m/blog/everything-you-need-to-know-about-introducing-a-covid-19-survey/

University of Wisconsin

https://www.uwrf.edu/COVID-19/EmployeeHealthScreeningQuestionnaire.cfm

Urology centre Alabama

https://www.urologycentersalabama.com/wp-content/uploads/2020/07/COVID-19-Screening-Questionnaire-7-1-2020-1.pdf

Turke Orthodontics

https://turkeorthodontics.com/wp-content/uploads/COVID-19-Pre-Screening-Questionnaire-4-29.pdf

Gastro Health

https://www.myganv.com/sites/default/files/VA001_2020%20COVID-19%20Pre-Appointment%20Questionnaire_Updated_05132020%20%281%29.pdf

Columbia University

https://www.tc.columbia.edu/preparedness/campus-life-during-covid-19/campus-access-requirements/daily-health-screening/

Wizzpass

https://wizzpass.com/blog-covid-19-screening-logging-of-staff-and-visitors/

Kanecenter

https://www.kanecenter.org/images/blog/Flu-COVID19_Screening_Questionnaire_-_General_rev_3.12.pdf

Steelcase

https://www.steelcase.com/resources/documents/visitor-questionnaire/

National Health Service (NHS)

https://www.leedsth.nhs.uk/assets/6ca53b1a6b/COVID-19-Screening-Questionnaire-Poster.pdf

Cravensport services

https://cravensportservices.ca/clientscreening/

New York State Funeral Directors Association

http://www.nysfda.org/images/COVID-19/daily_COVID-19_employee_health_screening_questionnaire.pdf

Immunize

https://www.immunize.org/clinic/screening-contraindications.asp

Correctional service Canada

https://www.csc-scc.gc.ca/001/006/001006-1009-en.shtml

Government of Canada

https://www.canada.ca/en/department-national-defence/services/benefits-military/education-training/establishments/canadian-forces-training-development-centre/annex-c-covid-19-self-assessment-questionnaire-bmq-joining-instructions-kit-list.html

CTV News

https://ottawa.ctvnews.ca/ottawa-public-health-develops-covid-19-assessment-tool-for-businesses-1.4946615

DYS Covid-19 Screening

https://www.mass.gov/guidance/dys-covid-19-visitor-screening

eLife

https://escholarship.org/content/qt7597065v/qt7597065v_noSplash_26b2fcf36cc04cb04885fca402709b5e.pdf

West Virginia Health and Human Resources

http://dhhr.wv.gov/COVID-19/Documents/Coronavirus-Guidance-Health-Screening-Questions.pdf

North Dakota Government

https://www.nd.gov/ndhp/about-us/capitol-security/covid-19-screening-questions

NY Government

https://doccs.ny.gov/system/files/documents/2020/07/doccs-covid-19-visitor-health-screening-questionnaire.pdf

SDCEP

https://www.sdcep.org.uk/wp-content/uploads/2020/05/Patient-COVID-19-screening-250520.pdf

International Development Association (IDA)

https://www.ida.org/-/media/corporate/files/general/covid-19-pre-visit-screening-questionnaire.ashx?la=en&hash=99A848BB002AC261CB700F5BA89207B7

Sussex community

https://www.sussexcommunity.nhs.uk/downloads/COVID-19%20documents/4a-g%20FINAL_Visitor_Screening_Questions_v2.pdf

Serenity Spa salon

https://serenityspasalonstatesboro.com/wp-content/uploads/2020/05/COVID-19-Screening-Checklist-for-Clients.pdf

Barry-Eaton Health

https://www.barryeatonhealth.org/sites/default/files/Screening%20and%20essential%20business%20guidance.pdf

Suny Polytechnic Insititute

https://sunypoly.edu/sites/default/files/fall2020plan/Coronavirus-Visitor-Questionnaire.pdf

Community Medical Centres

https://www.communitymedical.org/CMC/media/For-Healthcare-Professionals/COVID-19/Outpatient_COVID-19_Patient_Screening_Form.pdf

iAuditor

https://public-library.safetyculture.io/products/covid-19-jobsite-visitor-questionnaire

NHCHC

https://nhchc.org/wp-content/uploads/2020/04/COVID-homeless-screener-with-temp-and-screening-supply-list.xlsx.pdf

Master Builders Association

https://www.mbansw.asn.au/media/industry-news/questions-ask-your-workers-relation-covid-19

Carlisle

https://s22.q4cdn.com/386734942/files/doc_downloads/2020/Carlisle-Visitor-or-Contractor-Health-Questionnaire_Rev2.pdf