Employee health screening questionnaire form questions for COVID-19

Ask the right health questions to your employees

Resources / July 17, 2020

Many states and health departments have implemented mandatory employee symptom screening for symptoms related to the coronavirus (COVID-19). Designed to keep businesses and employees safe, the required screenings help businesses who are in closer contact with customers maintain a healthy workplace environment. In fact, many of these state regulations specifically call out certain types of businesses that need to regularly screen employees, such as:

  • Gym and fitness clubs
  • Restaurants
  • Barbers, salons and other personal care services
  • Offices
  • Retail stores
  • Hotels
  • Construction sites
  • And more

U.S. guidance

At the national level, the Centers for Disease Control and Prevention (CDC) provides top-level guidance about coronavirus screening questions that businesses can ask employees as they reopen. Many of these questions cover potential symptoms related to the coronavirus, like coughing, sore throat, or fever. The CDC recommends that businesses "[c]onsider encouraging individuals planning to enter the workplace to self-screen prior to coming onsite and not to attempt to enter the workplace if [symptoms] are present". The symptoms the CDC specifically recommends screening for are:

COVID-19 Symptoms from the U.S. CDC

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

In addition, the CDC recommends asking workers if they have had a fever greater than or equal to 100.4 F. Other useful questions from the CDC include:

  • If the employee has been tested for COVID-19 (and if they are waiting to receive test results)
  • If the employee has been diagnosed with COVID-19.

One other consideration from the CDC is asking employees if they have exhibited a new or unexpected symptom from the list above, in order to discard chronic symptoms they may be experiencing.

The CDC provides a symptom list for COVID-19 that many states refer to in their employee health screening guidance. You can read more about these symptoms of coronavirus on the CDC web site.

The U.S. Centers for Disease Control and Prevention provides a symptom list for COVID-19 that many states refer to in their employee health screening guidance
The U.S. Centers for Disease Control and Prevention provides a symptom list for COVID-19 that many states refer to in their employee health screening guidance


State guidelines

Individual states have also issued guidelines and regulations governing employee health screenings. These public health guidelines from states also include additional ideas for screening questions. In fact, some of these questions move beyond just symptom-based question to ask about risk factors that may influence whether an employee may have been exposed to COVID-19. These risk factor questions may include topics such as these:

Additional risk factor screening questions

  • South Dakota recommends asking "Are you caring for someone who is ill?"
  • New York requires asking if an employee has been in "close contact with confirmed or suspected COVID-19 case in past 14 days"
  • Delaware requires asking "Have you been in close contact (e.g., within 6 feet for more than 10 minutes) with a person with confirmed COVID-19 infection?"
  • Massachusetts requires asking if the employee has been "asked to self-isolate or quarantine by their doctor or a local public health official

Sample employee screening questionnaires

One state with a rigorous sample COVID employee screening form is Rhode Island. In it, the state recommends that employees, clients, and visitors be screened for symptoms of COVID-19. In addition to the typical symptoms of COVID-19, outlined above, they also recommend asking if a person has been exposed to specific risk factors, including the following questions:

  • Have you been in close contact (less than six feet) with anyone with COVID-19 or symptoms of COVID-19 in the past 14 days?
  • Have you traveled anywhere outside the 50 United States in the past 14 days?
  • Have you traveled to Rhode Island for a non-work-related purpose from another city, town, county, or state that currently has a stay-at-home restriction, a shelter-in-place restriction, or a similar restriction, declaration, or announcement due to a COVID-19 outbreak?
  • Have you been directed to quarantine or isolate by the Rhode Island Department of Health or a healthcare provider in the past 14 days? If so, when does/did your quarantine or isolation period end?

Rhode Island, as well as other states, provide samples of their employee health questionnaire screening forms as a base upon which you can develop a screener for your own company. You can see an example of the Rhode Island sample health screening questionnaire for COVID-19, as well as those for other states, at the links below:

Sample screener forms

State-by-state employee health screening and temperature guidelines

Picohealth has a list of employee health screening and temperature check requirements that includes details of requirements for each state.

Keep your business healthy

Reduce risk with automated employee health symptom screenings

Request demo