About this template
Maintaining a safe workspace requires proactive health and safety protocols. This Screening Checklist for Visitors and Employees template is designed to streamline daily wellness and exposure checks for anyone entering your facility. Whether you manage a busy healthcare clinic, a corporate office, or an essential service organization, this form captures essential contact details, current symptoms, temperature readings, and exposure history before individuals step on-site.
Using Doc2Form, you can instantly turn this structured checklist into a fully functional Google Form in seconds. The template includes fields for full names, specific symptom reviews, hand hygiene verification, temperature status, and recent travel or contact exposure. By collecting this information systematically, safety officers and facility managers can maintain accurate logs, reduce workplace transmission risks, and ensure a secure environment for staff and guests alike. Customize the questions to align with your organization's exact health guidelines or regulatory standards.
Key features
- Instant setup as a Google Form using Doc2Form
- Track visitor and employee symptoms accurately on any device
- Include temperature checks and exposure history questions
- Streamline daily facility access logs with zero friction
- Easily export and organize responses in Google Sheets
Use cases
- Daily staff health check-ins before entering office buildings
- Visitor logging and symptom screening at medical facilities and clinics
- Access control screenings for essential business operations
- Event attendee wellness verifications
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Role / Affiliation (Multiple choice)Select whether you are an employee, visitor, contractor, or vendor.
- Date of Visit (Date)Select today's date.
- Current Symptoms (Checkboxes)Select any new or worsening symptoms you are currently experiencing.
- Temperature Reading Status (Multiple choice)Was your temperature checked today?
- Exposure or Close Contact (Multiple choice)Have you had close contact with anyone diagnosed with a communicable illness in the past 14 days?
- Hand Hygiene Compliance (Multiple choice)Do you agree to sanitize or wash your hands upon entering the facility?
- Additional Notes or Comments (Paragraph)Provide any extra details regarding your health status if necessary.
FAQ
How do I use this screening checklist template?
Simply use Doc2Form to instantly convert this template into your own Google Form. You can then customize the questions, share the link with staff or visitors, and review submissions directly in Google Sheets.
Can respondents fill this out on their mobile phones?
Yes! Because the form runs on Google Forms, visitors and employees can easily open the link and complete the checklist on any smartphone, tablet, or computer.
Where are the submitted check-ins stored?
All responses are securely saved in your Google Drive account, allowing your HR or safety team to review logs and manage facility access in real time.
Can I add custom health questions specific to our facility?
Absolutely. Once the template is generated in your Google Forms account, you can freely edit, add, or remove questions to match your organization's safety policies.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.