| Employee Name | Date | Supervisor Administering Questionnaire | Approval to Work: | Employee temperature if taken at work: |
|---|---|---|---|---|
| Employee Name | Date | Supervisor Administering Questionnaire | Approval to Work: | Employee temperature if taken at work: |
| Employee Name | Date | Supervisor Administering Questionnaire | Approval to Work: | Employee temperature if taken at work: |
|---|---|---|---|---|
| Employee Name | Date | Supervisor Administering Questionnaire | Approval to Work: | Employee temperature if taken at work: |
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