Free Employee Health & Safety Screening Form

Elevate workplace safety standards with our Employee Health & Safety Screening Form Template by Template.net. This editable and customizable solution ensures streamlined health screenings for your team. Utilize our advanced Ai Editor Tool to tailor the form to your specific needs effortlessly. Prioritize employee well-being with ease. Get started today with Template.net.

Personal Information
Name:	[Name]
Job Title:	[Job Title]
Department:	[Department]
Date:	[MM-DD-YYYY]

Health Screening Questions	Yes	No
Have you experienced any flu-like symptoms in the past 14 days (fever, cough, difficulty breathing)?
Do you have any known allergies or medical conditions that the employer should be aware of? If yes, please specify.
[Peanut allergy and asthma]

Recent Travel and Exposure	Yes	No
Have you traveled internationally within the last 30 days?
Have you been in close contact with anyone diagnosed with or suspected of having COVID-19?

Workplace Safety Concerns	Yes	No
Do you have any current workplace safety concerns or suggestions? If yes, please describe.

Acknowledgment: I affirm that the information provided is accurate to the best of my knowledge.	[Signature]

Free Employee Health & Safety Screening Form

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