COVID-19 screening questionnaire form template
A COVID-19 screening questionnaire should be designed to identify individuals who may have symptoms of COVID-19 or who have been in close contact with someone who has tested positive for COVID-19.
- 1 page / 216 words.
- Last updated 11/04/2023.
- Designed for United Kingdom use.
- Suitable for use in other territories; check local laws first.
- Instantly download as Word / PDF / plain text, or send by email.
- Includes 12 months’ access, with all updates to this page provided free of charge and notified to you.
COVID-19 screening questionnaire form
- Have you experienced any of the following symptoms in the last 14 days? (Check all that apply)
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Fever or chills
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Cough
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Shortness of breath or difficulty breathing
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Fatigue
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Muscle or body aches
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Headache
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New loss of taste or smell
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Sore throat
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Congestion or runny nose
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A COVID-19 screening questionnaire is a set of questions designed to identify individuals who may have symptoms of COVID-19 or who have been in close contact with someone who has tested positive for COVID-19. The questionnaire typically includes questions about symptoms, recent travel, and potential exposure to COVID-19.
COVID-19 screening questionnaires can be used by healthcare facilities, employers, schools, and other organisations to help identify individuals who may need to be tested for COVID-19, self-isolate, or quarantine. The purpose of the questionnaire is to help prevent the spread of COVID-19 by identifying individuals who may be infected and taking appropriate precautions to limit their contact with others.
Depending on the situation, a COVID-19 screening questionnaire may be administered in person, online, or over the phone. It is important to ensure that the questionnaire is designed to collect accurate and relevant information, and that individuals are informed of the importance of answering the questions truthfully and to the best of their knowledge.
It is usually delivered to the Employee by the Employer / HR.
Compliance
Compliance
This COVID-19 screening questionnaire form template incorporates relevant UK laws and HR standards, including those listed below:
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General Data Protection Regulation (GDPR): Ensures that the collection and processing of personal data through the COVID-19 screening questionnaire comply with data protection principles.
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Health and Safety at Work Act 1974: Requires employers to assess and manage risks to health and safety, including implementing measures such as COVID-19 screening questionnaires to identify potential risks in the workplace.
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Equality Act 2010: Requires employers to consider reasonable adjustments and accommodations for employees with disabilities or underlying health conditions when implementing the COVID-19 screening questionnaire.
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The Control of Substances Hazardous to Health Regulations 2002: Provides a framework for employers to assess and control the risks associated with hazardous substances, including viruses like COVID-19, and implementing screening questionnaires can help identify potential exposure risks.
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The Health and Safety (Display Screen Equipment) Regulations 1992: Employers should consider the impact of remote work arrangements and implement screening questionnaires to assess the health and safety risks associated with working from home during the pandemic.
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The Management of Health and Safety at Work Regulations 1999: Employers have a duty to conduct risk assessments and take appropriate measures to protect the health and safety of employees, including implementing COVID-19 screening questionnaires to identify potential risks and implement control measures.
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The Public Health (Control of Disease) Act 1984: Provides legal powers to public health authorities to control the spread of infectious diseases, and implementing COVID-19 screening questionnaires can help identify and manage potential cases within the workplace.
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Occupational Health and Safety regulations: Depending on the industry, specific occupational health and safety regulations may require the implementation of COVID-19 screening questionnaires as part of risk management and prevention strategies.
Frequently Asked Questions
Frequently Asked Questions
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Can I use this template in my small business?
Yes. The COVID-19 screening questionnaire form template is designed to be flexible and suitable for organisations of all sizes, including small businesses and charities. It follows UK employment law best practice, so even if you don't have an in-house HR team, you can confidently apply it.
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Is this template compliant with 2025 UK employment law?
Absolutely. All of our templates are drafted with the latest ACAS guidance and UK employment legislation in mind. We review and update them regularly, so you can be confident they remain compliant.
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Can I customise it for my organisation?
Yes, we highlight the areas that you need to update with your own details, and where you need to make decisions to suit your situation. This saves you time and ensures that you meet best practice.
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Do I get instant access?
Yes. Once purchased, you'll be able to download it instantly. Templates are provided in editable Word or Excel format so you can customise them easily, and in PDF format for easy sharing.
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What if I need more help, not just this template?
If you're looking for broader support, we also offer toolkits and library bundles that include this template, along with other HR templates and policies for fully managing your situation. These may be more cost-effective if you need deeper advice.
