CCFD Daily Employee Screening
INTENT: To provide early detection of COVID-19 infection and to prevent potentially infected employees from entering the workplace and thus reduce the risk of exposure to co-workers and the community. This form also meets the intent of SMCO Health Guidelines for General Employee Health Monitoring, and also for Self-Monitoring and Self-Monitoring with Delegated Supervision after Low Risk Exposures.
• Measure your temperature and consider the presence of any symptoms twice per day, every day (morning and evening, on and off duty).
• Measure your temperature and any symptoms before leaving home to report for work. This pre-work screening will be considered one of the twice daily screenings.
• If you develop a fever greater than 100.0*F or any symptoms, immediately self-isolate and notify the Duty Battalion Chief.
• Persistent Cough
• Body Aches
• Shortness of Breath, unrelieved with rest.
• Loss of taste or smell
• Unexplained gastrointestinal disturbance (nausea, vomiting, abdominal pain or diarrhea)
• Recorded each screening on a CCFD Daily Employee Screening Form.
Enter department email to identify yourself. Upon completion, you will receive a confirmation email.
Date of screening
Time of Day:
Select Apparatus, Division, or Off Duty
Select any symptoms that you are experiencing:
Shortness of Breath, unrelieved with rest
Never submit passwords through Google Forms.
This form was created inside of Central County Fire Department.