This document contains an employee COVID-19 self-screening questionnaire used to screen employees before entering the workplace. It asks for the employee's name, contact details, and whether they have experienced common COVID-19 symptoms or potential exposure to the virus in the last 14 days. Any employee answering yes is not allowed to enter and must self-isolate and notify managers. The questionnaire aims to help prevent the spread of COVID-19 in the workplace by screening for potentially infected individuals.
This document contains an employee COVID-19 self-screening questionnaire used to screen employees before entering the workplace. It asks for the employee's name, contact details, and whether they have experienced common COVID-19 symptoms or potential exposure to the virus in the last 14 days. Any employee answering yes is not allowed to enter and must self-isolate and notify managers. The questionnaire aims to help prevent the spread of COVID-19 in the workplace by screening for potentially infected individuals.
This document contains an employee COVID-19 self-screening questionnaire used to screen employees before entering the workplace. It asks for the employee's name, contact details, and whether they have experienced common COVID-19 symptoms or potential exposure to the virus in the last 14 days. Any employee answering yes is not allowed to enter and must self-isolate and notify managers. The questionnaire aims to help prevent the spread of COVID-19 in the workplace by screening for potentially infected individuals.
This document contains an employee COVID-19 self-screening questionnaire used to screen employees before entering the workplace. It asks for the employee's name, contact details, and whether they have experienced common COVID-19 symptoms or potential exposure to the virus in the last 14 days. Any employee answering yes is not allowed to enter and must self-isolate and notify managers. The questionnaire aims to help prevent the spread of COVID-19 in the workplace by screening for potentially infected individuals.
1) Have you had any of the following symptoms in the last 24 hours? 2) In the last 14 days have you: 1) Have you had any of the following symptoms in the last 24 hours? 2) In the last 14 days have you:
YES NO YES NO YES NO YES NO
Cough Cough Shortness of breath or difficulty breathing Been in contact with someone who was diagnosed Shortness of breath or difficulty breathing Been in contact with someone who was diagnosed with COVID-19? with COVID-19? Fever Fever Chills Chills Been in close contact with someone who had Been in close contact with someone who had Muscle pain COVID-19 symptoms? Muscle pain COVID-19 symptoms? Headache Headache Sore throat Traveled internationally or taken a cruise? Sore throat \ Traveled internationally or taken a cruise? Loss of taste or smell Loss of taste or smell
NOTE: If you answered “YES” to any of the questions, you are not allowed to enter the building You should isolate yourself for self-quarantine for at NOTE: If you answered “YES” to any of the questions, you are not allowed to enter the building You should isolate yourself for self- least 14 days from the date on which you first experienced any of the above symptoms, contact your health care professional for recommended next quarantine for at least 14 days from the date on which you first experienced any of the above symptoms, contact your health care steps and notify your manager and HR. professional for recommended next steps and notify your manager and HR.
I certify to the best of my knowledge; this information is accurate. I certify to the best of my knowledge; this information is accurate.
5F South Tower, The Centrium Building, Aseana Avenue, Baclaran, Parañaque City 5F South Tower, The Centrium Building, Aseana Avenue, Baclaran, Parañaque City
1) Have you had any of the following symptoms in the last 24 hours? 1) Have you had any of the following symptoms in the last 24 hours? 2) In the last 14 days have you: NOTE: If you answered “YES” to any of the questions, you are not allowed to enter the 2) In the lastYou building 14 days have should you:yourself for self-quarantine for at isolate least 14 days from the date on which you first experienced any of the above symptoms, contact your health care professional for recommended next steps NOTE: If you answered “YES” to any of the questions, you are not allowed to enter the building You should isolate yourself for self-quarantine for at and notify your manager and HR. YES any ofNO YES NO YES NO least 14 days from the date on which you first experienced the above symptoms, contact your health care professional for recommended YES next NOsteps andCough notify your manager and HR. I certifyCough to the best of my knowledge; this information is accurate. Shortness of breath or difficulty breathing Shortness of breath or difficulty breathing Been in contact with someone who was diagnosed Been in contact with someone who was diagnosed Fever with COVID-19? Fever I certify to the best of my knowledge; this information is accurate. with COVID-19? Chills Chills Been in close contact with someone who had Been in close contact with someone who had Muscle pain Muscle pain COVID-19 symptoms? COVID-19 symptoms? Headache Headache Sore throat Sore throat Traveled internationally or taken a cruise? Traveled internationally or taken a cruise? Loss of taste or smell Loss of taste or smell
