Covid-19 Screening Checklist.
(Clientele) Covid-19 Screening Checklist required before commencing for daily Operational Duty.
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Email *
Name and Surname *
Mobile number *
Work number *
ID Number *
Where are you? *
DO YOU HAVE THE FOLLOWING SIGN OR SYMPTOM? *
Yes
No
Do you have a Fever above 38°C?
Do you have a Cough?
Do you have a Sore Throat?
Do you have a Shortness of Breath?
Do you have Body Aches?
Do you have Redness of Eyes?
Do you have Loss of Taste or Smell?
Do you have Nausea, Vomiting or Diarrhea?
Do you have Fatigue / Weakness?
In the last 14 days, in your community, were you in close contact or living with any of the following: Close contact means you were face-to-face (less than 1 meter) with the person or you were in a closed space (car, taxi or house) with the person for at least 15 minutes, *
Yes
No
A person with flu-like symptoms
A person positively tested for COVID-19 or a person under investigation for COVID-19
Have you been diagnosed with flu or pneumonia in the last 14 days?
If your answer is yes to any of the above, an explanation is required.
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