TOURtech COVID-19 Health Screen Questionnaire

COVID-19 Health Screen

Coronavirus Disease (COVID-19) Workplace Health Screening

In the past 24 hours, have you experienced:

Subjective fever (felt feverish) *
New or worsening cough *
Shortness of breath *
Sore throat *
Diarrhea *
If you answer “yes” to any of the symptoms listed above, or your temperature is 100.4°F or higher, please do
not go to into work. Self-isolate at home and contact your primary care physician’s office for direction.
• You should isolate at home for a minimum of 7 days since symptoms first appear.
• You must also have 3 days without fevers and improvement in respiratory symptoms.

In the past 14 days, have you:

Had close contact with an individual diagnosed with COVID-19? *
Traveled via airplane internationally or domestically? *
If you answer “yes” to either of these questions, please do not go into work. Self-quarantine at home for 14