Personnel Health Screening Form: Effective 9/30/20

Any business or entity that is allowed to operate in San Francisco during the COVID-19 pandemic MUST screen Personnel with the questions below on a daily basis as part of its Social Distancing Protocol compliance and provide this information to Personnel. Go to for more information or to view this form.

You can view the form at:

If you have any questions, please contact the office at 415-664-8331.

*Form based on SFDPH Order Dated 9/30/20
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