Covid-19 Daily Screening Register - South Africa
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Screening Ref#
Pending
Name & Surname
Site / Office
ID Number
Screening Date
Contact Number
International travel in past 14 days?
No
Yes
In contact with + Covid person in last 14 days?
No
Yes
If so, in the office?
No
Yes
Have you tested positive for Covid-19 in the past?
No
Yes
Supplied HR with certificate confirming negative?
No
Yes
Fever not attributable to other health condition?
No
Yes
Sore throat not attributable to other condition?
No
Yes
Cough not attributable to other condition?
No
Yes
Redness of eyes?
No
Yes
Shortness of breath?
No
Yes
Body Ache not attributable to other condition?
No
Yes
Loss of smell?
No
Yes
Loss of taste?
No
Yes
Nausea?
No
Yes
Vomitting?
No
Yes
Diarrhoea?
No
Yes
Fatigue?
No
Yes
Weakness or tiredness?
No
Yes
Category
Covid-19
Sub Category
Health Screening
Priority
Low
Medium
Urgent
Logging Person
Full Name
Email Address
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