Daily Health Questionnaire

To be completed by all staff prior to leaving for the office each day. You may be refused entry if you do not complete this.

Phone
This field is for validation purposes and should be left unchanged.
Employee Name*
Your Temperature*
Please enter a number from 34 to 40.
Above 37.5 degrees please do not come to the office or arrange to return home. Below 35 degrees is considered hypothermia.
IT WOULD APPEAR YOUR TEMPERATURE IS TOO LOW! Please go to a doctor immediately as you could be dead, in a life-threatening state or else you misread the thermometer. Please check again.
Have you completed your Covid Test?*
- Not Applicable
- Negative
- Postive
Are you feeling unwell or displaying any symptoms of illness, including cough, sore throat, runny nose, shortness of breath, loss of smell or any other symptoms of being unwell?*
- No
- Yes
Are you the subject of a current Quarantine, Isolation, Shielded Persons or Stay-Home notice order?*
- No
- Yes
Declaration*
I confirm that I have taken a temperature reading this morning, using a suitable thermometer. I declare that the above answers are true to the best of my knowledge. I understand that providing any false information may be an offence under law. I also understand that if any symptoms develop, I have a responsibility to make my Line Manager aware and that I may be directed to seek medical attention immediately.

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