Free Cleaning Services Health Screening Form

Generate a precise health screening form effectively in just a few easy clicks with the Cleaning Services Health Screening Form Template! This customizable form from Template.net is editable, allowing you to conduct a detailed health screening. The AI Editor Tool simplifies the editing process, helping you maintain a healthy workforce!

Field	Information
Name:
Date of Birth:
Gender:	Male Female Other:

Section	Question	Response
Health History	Do you have any pre-existing medical conditions?	Yes No
	If yes, please specify:
	Are you currently taking any medication?	Yes No
	If yes, please specify:
Symptoms	Do you currently have any COVID-19 symptoms?	Yes No
Symptoms	If yes, please specify:
Exposure Risk	Have you been in close contact with anyone diagnosed with COVID-19 in the past 14 days?	Yes No
Exposure Risk	Have you traveled internationally in the past 14 days?	Yes No
Temperature Check	Current Temperature:
Temperature Check	Time of Measurement:

Free Cleaning Services Health Screening Form

Personal Information

Health Screening Form

Health Declaration

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