About this template
The Visitor and Employee Health Screening Form is an essential tool for organizations prioritizing workplace safety and health monitoring. This template allows you to systematically collect wellness data from anyone entering your premises, ensuring that you maintain a clear record of potential health risks while adhering to internal safety protocols.
Designed for ease of use, this form captures critical information such as recent symptoms, temperature readings, and exposure history. It is ideal for human resources departments, facility managers, and healthcare administrators who need a reliable, digital way to screen individuals before they access shared spaces. By moving away from paper-based logs, you gain a searchable, time-stamped database of all entries, which is vital for maintaining operational transparency and staff well-being.
Key features
- Quickly record temperature and symptom status.
- Easily accessible on any mobile device or tablet.
- Centralize all screening data in a secure Google Sheet.
- Customizable to include specific site-entry requirements.
- Streamline the check-in process for visitors and staff.
Use cases
- Daily employee health check-ins at manufacturing plants.
- Visitor registration for hospitals and medical clinics.
- On-site screening for corporate office re-entry.
- Safety compliance tracking for construction job sites.
What this form collects
- Full Name (Short answer)Please provide your full legal name.
- Role (Multiple choice)Select your current status.
- Date of Entry (Date)Select the date of your visit.
- Current Temperature (Short answer)Please enter your temperature reading in degrees Fahrenheit.
- Symptom Checklist (Checkboxes)Have you experienced any of the following in the last 48 hours? Select all that apply.
- Exposure Status (Multiple choice)Have you been in close contact with anyone diagnosed with a contagious illness in the last 14 days?
- Hand Hygiene Compliance (Multiple choice)Have you sanitized or washed your hands upon entry?
- Additional Notes (Paragraph)Please provide any additional information or context if necessary.
FAQ
Can I add my company logo to this form?
Yes, you can customize the header of your Google Form with your company logo and brand colors directly in the Google Forms editor.
Where is the data stored?
All responses are automatically saved to your Google Drive, where you can view them in the 'Responses' tab or export them to a Google Sheet.
Is this form mobile-friendly?
Yes, Google Forms are fully responsive and work seamlessly on smartphones, tablets, and desktop computers.
Can I share this form via a QR code?
Absolutely. Once you generate your form, you can create a QR code pointing to the link and display it at your building entrance for easy scanning.
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.