Daily Health Monitoring Sheet

Track staff body temperature and symptoms each day, along with recent travel and contact history, to help flag potential health risks early.

Use this template

Date

Name

First Name

Last Name

BODY TEMPERATURE

Sex

Age

Residence Address

Nature of Visit

(If Official, please fill in company name and address)

Are you experiencing:

Have you worked together or stayed in the same close environment of a confirmed COVID-19 case?

Have you had any contact with anyone with fever, cough, colds and sore throat in the past 2 weeks?

Have you travelled outside of your state in the last 14 days?

Have you travelled to any area in NCR aside from your home?

If yes, please specify

Signature

Sign here

Date Signed

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