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Body Temperature
Do you know the symptoms of Covid-19?
Yes
No
Dry Cough?
Yes
No
Fatigue?
Yes
No
Coughing up slime?
Yes
No
Shortness of breath?
Yes
No
Sore throat?
Yes
No
Headache?
Yes
No
Muscle or joint pain?
Yes
No
Body chills?
Yes
No
Nausea or vomiting?
Yes
No
Nasal congestion?
Yes
No
Diarrhoea?
Yes
No
Coughing up of blood?
Yes
No
Redness of Eyes?
Yes
No
Have you been in contact with anyone that showed signs of the above symptoms?
Yes
No
Did the employer provide you with information about Covid-19?
Yes
No
Do you know the correct way to wash your hands?
Yes
No
Did the employer inform you about all the risks and hazards in the office environment?
Yes
No
Do you see your working environment as safe?
Yes
No
Did the employer provide you with a facemask?
Yes
No
Comments
Body Temperature
Do you have any of the COVID-19 symptons?
Yes
No
Have you been in contact with anyone who has tested positive for COVID in the last 14 days?
Yes
No
Your Company
Have you been in contact with anyone who has tested positive for COVID in the last 14 days?
Yes
No
Any COVID symptoms?
Yes
No
Your Company
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