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Employee Covid 19 Screening Form

Employee Covid-19 Screening Form

Allows entry of symptoms that are chronic and employee health is aware of. If criteria is not met no temp or submit button is shown. If criteria is met then info is submitted to integrated Google sheet. HIPAA compliant is a must.

Employee Information

Please provide the following information

Email*

First Name*

Last Name*

Date of Birth*

Select date

Gender*

Employee ID*

Department*

Supervisor*

Phone Number*

10.

Emergency Contact Name*

11.

Emergency Contact Phone Number*

Description:Screen employees for COVID-19 symptoms with this HIPAA-compliant form. Only visible if criteria is met, this form allows entry of chronic symptoms that the employee's health is aware of. Once submitted, the information is integrated into a Google Sheet.

Protect your workplace with this COVID-19 screening form for employees. Designed to be HIPAA-compliant, this form ensures that employee health information is kept confidential. The form is only visible if the criteria are met, and it allows entry of chronic symptoms that the employee's health is aware of. If the criteria are not met, no temperature or submit button is shown. Once the criteria are met and the form is submitted, the information is integrated into a Google Sheet for easy tracking and monitoring. Keep your workplace safe and healthy with this easy-to-use screening form.

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Nomor Induk Kependudukan (NIK)*

Tanggal Lahir*

Select date

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