Would anyone be willing to share their COVID-19 questionnaire used for facility visitors and/or employees?

Would anyone be willing to share their COVID-19 questionnaire used for facility visitors and/or employees? Some that we have seen were from early on when only certain countries and regions were hotspots. Also, do you include release wording allowing for taking temperatures of all visitors and employees?

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asic:

• Do you or anyone in your household have any of the following symptoms: fever, cough, shortness of breath?
• Have you been exposed to anyone with COVID-19?
• If yes, have you been tested?

Yes to any of these results in a further discussion with HR to determine if employee is allowed into the facility.

This was in the Webinar last week and what we used for our questions

 

General Screening Questions:

1. What is your name?
2. In the last 24 hours, have you experienced or had any of the symptoms?
   •  Fever? 
   • Cough?
   • Difficulty breathing or shortness of breath?
3. Have you traveled within the last 14 days to a high-risk area (widespread community transmission)?
4. In the last 14 days, have you been in contact with someone who has been diagnosed with COVID-19?
5. If "yes", please explain: When did travel or exposure happen?

Nice idea, thank you...

 

 

This was in the Webinar last week and what we used for our questions

 

General Screening Questions:

1. What is your name?
2. In the last 24 hours, have you experienced or had any of the symptoms?
   •  Fever? 
   • Cough?
   • Difficulty breathing or shortness of breath?
3. Have you traveled within the last 14 days to a high-risk area (widespread community transmission)?
4. In the last 14 days, have you been in contact with someone who has been diagnosed with COVID-19?
5. If "yes", please explain: When did travel or exposure happen?