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Health Screening Form

Screen staff or visitors for symptoms before they arrive on site, with a dated record you can keep for as long as policy requires.

Health Screening Form

Screen staff or visitors for symptoms before they arrive on site, with a dated record you can keep for as long as policy requires.

Symptoms

In degrees Celsius.

Contact

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Use this template

Opens in the builder. Nothing is saved until you edit it.

Fields
9 questions
Theme
Forest, switchable in the preview
Updated
11 August 2026

Categories

  • Healthcare
  • Healthcare Forms
  • Screening Forms
  • Compliance Forms

Ideal for

  • Facilities teams
  • Office managers
  • Event organisers
  • Clinics

Best used in

  • Site access
  • Visitor management
  • Care settings

About this template

Screening at the door creates a queue and no record. Sent the day before, this form gives you a timestamped declaration per person, which is the thing you actually need if you have to reconstruct who was on site during an outbreak. It takes under a minute and asks nothing beyond what a policy can justify.

Symptoms, contact, and travel are kept as three separate questions because they trigger different responses. Someone with symptoms should not come in, whereas recent contact might only mean a test, and merging them into one yes or no throws away the distinction that decides what you do next.

The declaration checkbox is what turns this from a survey into a record. Set a retention period that matches your policy and delete on schedule, and drop the temperature field unless you actually issue thermometers, since an unmeasured guess is worse than no reading.

Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.

Fields in this template

  • Full name*Short text
  • Email address*Email
  • You are*Single choice
  • Date of your visit*Date
  • In the last 48 hours, have you had any of these?Multiple choice
  • Temperature reading, if you have taken oneNumber
  • Have you been in close contact with anyone unwell?*Single choice
  • Any travel in the last 14 days?Long text
  • Declaration*Multiple choice

Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.

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