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Covid-19 Health Assessment
DescriptionThe Covid-19 Health Assessment form provides a quick check for staff to identify their risk and ensure you are taking the proper precautions for the safety of your business, staff, and customers.
Employee Data 6 Questions
Employee First Name
Employee Last Name
Symptoms 6 Questions
I have travelled internationally in the last 14 days.
I have had contact with someone with confirmed COVID-19 in the last 14 days.
I have NOT experienced any health concerns in the past 14 days.
Please indicate which symptoms you have experienced in the past 14 days:
I do NOT have any existing health conditions.
Please indicate which conditions you have been diagnosed with in the past: