🧴 Pre-Shift Screening Form Template

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Employee Name

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Employee ID

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Did you or anyone you came in close contact with travelled internationally in the last 14 days?

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Have you had any close contact with someone who has been diagnosed with COVID-19 or has experienced COVID-like symptoms within the past 14 days?

Have you experienced any of the following symptoms in the last 14 days?
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Fever

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Dry Cough

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Tiredness

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Aches and Pains

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Sore Throat

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Headache

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Loss of Taste or Smell

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Conjunctivitis

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Diarrhea

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