Start of Day Health Report
Please fill out this form before every workday.
Completed By
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Supervisor
*
First Name
Last Name
Job Name
*
Are you free from injury when reporting to work?
*
Yes
No
Are you free from direct exposure to a positive COVID-19 or suspected positive case?
*
Yes
No
Signature
Submit
Should be Empty: