This tool is intended to simplify the screening process for Demo Company Name.

Please use this tool to complete COVID-19 self-screening prior to coming to the workplace.

You are required to self-screen every day that you are present at the workplace and may be asked to show the result when entering the building.

I attest that the information provided is accurate to the best of my knowledge.

Latest Announcement

1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

• Fever or chills
• Difficulty breathing or shortness of breath
• Cough
• Sore throat, trouble swallowing
• Runny nose/stuffy nose or nasal congestion
• Decrease or loss of smell or taste
• Nausea, vomiting, diarrhea, abdominal pain
• Not feeling well, extreme tiredness, sore muscles

2. Have you travelled outside of the country in the past 14 days?

3. Have you had close contact with a confirmed or probable case of COVID-19?