Health Assessment Form — DVS Drywall Contractors

COVID-19 Health Assessment Form

It is imperative that you are honest when filling out this form. We all have to do our part to help control the spread of this virus. By filling this out honestly, you are helping to ensure the construction industry continues to be an essential service and we all stay safe.

Name

First Name

Last Name

Date

YYYY

Site location

Are you feeling unusually tired or sore today?

Do you know if or feel like you have a fever?

Do you have a cough?

Are you having a hard time breathing?

Do you feel like you might be coming down with a cold or the flu?

Is anyone in your household currently sick with a cold or flu?