COVID-19 Daily Screening Log

DATE NAME TEMPERATURE <100.4°F COUGH

NEW SHORTNESS OF

BREATH

ASKED TO GO HOME (Note Time Dismissed)

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No

Yes No Yes No Yes, Time: No