Sample Employee Health Screening
Survey for COVID-19

You can customize the questions to match your local requirements
1
Diagnose
2
Close
Contact
3
Symptoms
Diagnose

Within the last 10 days have you been diagnosed with COVID-19 or had a test confirming you have the virus?

1
Diagnose
2
Close Contact
3
Symptoms
Close Contact

Within the past 14 days, have you been in    close physical contact   (6 feet or closer for at least 15 minutes) with a person who is known to have laboratory confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19?

You are a close contact of a COVID-19 positive person if, from 48 hours before their symptoms began, the person with COVID-19:
  • Lived or stayed overnight with you
  • Was your intimate sex partner *
  • Took care of you or you took care of them
  • Stayed within 6 feet of you for more than 10 minutes while they were not wearing a face mask
  • Exposed you to direct contact with their body fluids or secretions (e.g., coughed or sneezed on you) while you were not wearing a face mask, gown, and gloves

* You can edit more sensitive to questions to meet your business needs and still comply with state and local mandates.

* You can also include   travel related    questions to handle special cases such as for out of state travel or recent cruise-line trips. Just contact us for more information at support@healthyscreen.ai

1
Diagnose
2
Close Contact
3
Symptoms
Symptoms

Have you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by a pre-existing condition?

  • Fever (100.4°F/38.0°C or greater), Chills, or Repeated Shaking/Shivering
  • Cough
  • Sore Throat
  • Shortness of Breath, Difficulty Breathing
  • Feeling Unusually Weak or Fatigued
  • Loss of Taste or Smell
  • Muscle pain
  • Headache
  • Runny or congested nose
  • Diarrhea
  • Nausea or Vomiting

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Employee after health screening
HealthyScreen employee health screening compliance made easy

HealthyScreen is a leading provider of employee health screening and wellness assessment solutions for businesses, organizations, and conferences of all sizes. Our employee and guest symptom and vaccination tracking solution enables you to easily manage daily health screenings while complying with local laws, state mandates and OSHA guidelines. Our multi-lingual solution has delivered over one million surveys.

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