Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois

Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois

Employee Symptom Screening Form for Workplaces (Non-healthcare) is a legal document that was released by the Illinois Department of Public Health - a government authority operating within Illinois.

FAQ

Q: What is the purpose of the Employee Symptom Screening Form?A: The purpose of the form is to assess the health status of employees before they enter the workplace.

Q: Who should complete the Employee Symptom Screening Form?A: All employees (excluding healthcare workers) should complete the form.

Q: What information is included in the form?A: The form includes questions about symptoms, exposure to COVID-19, and recent travel history.

Q: Is the completion of the form mandatory?A: Yes, completing the form is mandatory for all employees (excluding healthcare workers) entering the workplace.

Q: Can an employee enter the workplace without completing the form?A: No, employees must complete the form before entering the workplace.

Q: What should an employee do if they have symptoms or exposure to COVID-19?A: An employee with symptoms or exposure should not enter the workplace and should follow the recommended guidelines, such as self-isolating and contacting a healthcare provider.

Q: Who has access to the information provided in the form?A: The employer and designated personnel responsible for employee health and safety have access to the information.

Q: How long should the form be retained?A: The form should be retained for at least 60 days, in accordance with privacy guidelines.

ADVERTISEMENT

Form Details:

  • Released on May 16, 2020;
  • The latest edition currently provided by the Illinois Department of Public Health;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Illinois Department of Public Health.

Download Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois

4.8 of 5 (15 votes)
  • Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois

    1

  • Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois, Page 2

    2

  • Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois, Page 1
  • Employee Symptom Screening Form for Workplaces (Non-healthcare) - Illinois, Page 2
Prev 1 2 Next
ADVERTISEMENT