Employee COVID-19 Questionnaire [+ Free Template]

By Adam Day

November 20, 2020

COVID-19 employee questionnaires that screen for symptoms are useful for mitigating workplace risks and limiting the spread of the virus. Moreover, they also encourage employee self-responsibility.

The purpose of these surveys isn’t to scrutinize or ostracize employees but rather, to promote an open dialogue that keeps them and everyone around them safe. 

In today’s climate, employee health and safety should begin before entering the workplace. Self-screening and pre-screening policies, therefore, are an important component when it comes to workplace COVID safety.

What Can Employees and Office Visitors Do?

Employees and visitors should monitor for symptoms that include fever, cough, and body aches. In addition, employees should avoid coming to work if they’re feeling unwell.

Along these same lines, you should enact policies that reduce the comings and goings in the workplace and work to minimize exposure. 

  • Encourage employees to self-screen before work
  • Ask visitors to report symptoms before checking in
  • Institute symptom reporting policies
  • Offer alternatives to in-person interactions

What Legislation Should You Be Aware Of?

A lot of employees may feel sensitive about filling you in on the more intimate details of their health. In addition, you have to be legally compliant when putting together a COVID questionnaire.

Therefore, it’s a good idea to familiarize yourself with the Americans with Disabilities Act (ADA) and the Rehabilitation Act and other employee privacy mandates, most notably HIPAA. This should make you aware of what not to ask employees and what they’re actually obliged to tell you. 

For example, you can’t ask if someone is immunocompromised. Instead, ask if they feel they’re more susceptible or at a higher risk for COVID-19. Moreover, you’re still restricted from asking why. However, the ADA states that, “during a pandemic, ADA-covered employers may ask such employees if they are experiencing symptoms of the pandemic virus.”

What to Keep in Mind When Putting Questions Together

It’s essential you structure questions in a way that encourages mindful reflection and transparency. The aim of the game is to keep it simple and specific.

A well-designed survey can and should become part of your workplace’s essential health screening process. Questions should focus on an employee’s current health, any potential exposures to coronavirus, their feelings about safety and wellbeing and willingness to adhere to workplace health and safety protocols. Implementing such tools is acting in the best interests of your employees’ morale and health.

Employee COVID Questionnaire Template

A number of organizations provide specific guidance on what to ask in a coronavirus employee questionnaire template. These include:

The following is an example question set, based on official guidance. For more information on setting up a screening process within your business, read our HR Guide to Screening Employees for COVID-19.

  1. In the past 48 hours, have you experienced any of the following COVID-19 symptoms? 
  • Fever or chills 
  • Cough 
  • Shortness of breath or difficulty breathing 
  • Fatigue
  • Muscle or body aches
  • Headache 
  • Recent loss of taste or smell 
  • Sore throat 
  • Congestion 
  • Nausea or vomiting 
  • Diarrhea 


  1. Have you had close contact with anyone with a confirmed or probable case of COVID-19? OR Within the past 14 days, have you had contact with anyone who had COVID-like symptoms? (Close contact being 6 feet (2 meters) or closer for more than 15 minutes).


  1. Within the past 14 days, has a public health or medical professional, or public health guidance, told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection? OR are you worried you may be sick with COVID-19?


  1. Are you currently waiting for the result of a COVID-19 test?


If you answered NO to ALL of the above questions, then you are cleared to enter the workplace to complete your shift.

If you answered YES to ANY of the above questions, then you are not permitted to enter the workplace. Please remain in/return to your home and follow the relevant public health guidance in your area with regards to how to access a COVID-19 test. 

  1. Finally, please confirm that you have read and understood the company’s COVID-19 precautions to help prevent the spread of COVID-19 and that you agree to abide by them?


Final Thoughts

Rolling out an employee COVID-19 questionnaire to all staff and visitors to complete each time they start their shift or visit can help to stop the spread of the virus.

Be sure to have protocols in place should any of your employees’ report positive answers to symptoms or contact with people who have been sick. Encourage responsible use of the survey and set up support systems that can boost staff morale and maintain workplace trust during such a difficult time.



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