2020 Fitness Facility Staff Daily Self Health Check
This form must be completed daily before you report to work. Please complete one health check per day, regardless of the number of shifts you work.
* Required
Name
*
Your answer
Your Temperature this morning
*
Your answer
Have you had any of the following symptoms in the past 24 hours?
*
Shortness of Breath
Cough
Chills
Repeated Shaking with chills
Muscle Pain
Headache
Sore Throat
New loss of taste and/or smell
Rash
I have not had any of these symptoms
Required
In the past 14 days, have you had contact with someone diagnosed with COVID-19?
*
Yes
No
Submit
Never submit passwords through Google Forms.
This form was created inside of Lakewood City Schools.
Report Abuse
Forms
