CDC: COVID-19 Daily Office Safety/Health Checklist for Onsite Personnel

Run this checklist each day before reporting to work to assess fitness to work.

Introduction:

Record basic details

Check for a fever

Check for loss of smell/taste

Check for a cough

Check for muscle aches

Check for a sore throat

Check for a shortness of breath

Check for chills

Check for a headache

Check for nausea/vomiting, diarrhea, loss of appetite

Assess whether you've been in contact with COVID-19

[Conditional] Stay home

[Conditional] Proceed to work

Approval: Final approval

Sources:

Related checklists:

Introduction:

This checklist template is part of our Coronavirus Workplace Processes pack.

It was built following the procedures outlined by the US Centers for Disease Control and Prevention (CDC).

If you are an on-site employee, please use this COVID-19 Daily Self Checklist each day before reporting to work.

This checklist is meant to be completed each day by onsite personnel, before reporting to work. It provides a step-by-step guide on checking for COVID-19 symptoms to help limit any further spread of the virus.

Though this checklist has all the basic necessary information, you can also choose to edit it to better suits your specific needs. You can add/edit form fields and widgets throughout the checklist to help gather necessary information and sync your Process Street account with other software you may be already using to easily store and use the information from your checklists.

When the template is ready and would like to use it, all you have to do is run the template as a checklist.

Process Street is not a medical institution and the items contained in this process template are illustrative and not intended to be understood as medical advice. Please refer to the attached PDF document for any and all medical or operational recommendations.

Record basic details

Use the form fields below to record basic information first.

Your first name

Your last name

Today's date

Supervisor

Check for a fever

Do you have a fever (over 100.30F) without having taken any fever reducing medications?

Do you have a fever?

1

Yes
2

No

Check for loss of smell/taste

Do you have a loss of smell or taste?

1

Yes
2

No

Check for a cough

Do you have a cough?

1

Yes
2

No

Check for muscle aches

Do you have muscle aches?

1

Yes
2

No

Check for a sore throat

Do you have a sore throat?

1

Yes
2

No

Check for a shortness of breath

Do you have shortness of breath?

1

Yes
2

No

Check for chills

Do you have chills?

1

Yes
2

No

Check for a headache

Do you have a headache?

1

Yes
2

No

Check for nausea/vomiting, diarrhea, loss of appetite

Have you experienced any gastrointestinal symptoms such as nausea/vomiting, diarrhea, loss of appetite?

Have you experienced any nausea/vomiting, diarrhea, or loss of appetite?

1

Yes
2

No

Assess whether you've been in contact with COVID-19

Have you, or anyone you have been in close contact with been diagnosed with COVID-19, or been placed on quarantine for possible contact with COVID-19?

Have you been in contact with someone diagnosed with COVID-19?

1

Yes
2

No

[Conditional] Stay home

If you replied "Yes" to any of the questions in this checklist, stay home (with pay) and follow the steps below:

Call your supervisor to notify them
Call/email the COVID-19 HR Response Team at 413-687-2283 or [email protected].

Feel free to use the Send Email form field below to contact the COVID-19 HR Response Team:

[Conditional] Proceed to work

If you answered “No” to all of the questions, you can go to work as normal or visit your work.

If you begin to develop any new symptoms, redo the checklist to reevaluate your fitness to work.

Note: If you're experiencing any other new symptoms that weren't listed in the checklist, then you should stay home and minimize close contact with others until the symptoms pass.