Health Monitoring Slip HR
Welcome to our Health Monitoring Slip, designed to ensure comprehensive tracking of your health status. Your participation in providing accurate and timely information empowers us to deliver personalized care and support. Please fill out the following details to facilitate effective monitoring and management of your health.
EMPLOYEE INFORMATION
Employee Name: [Employee's Name] | Date: [Month Day, Year] |
Department: Design Department | Employee ID: 100-10-602 |
HEALTH STATUS
Please indicate your current health status |
No symptoms of illness
Experiencing symptoms of illness (please specify):
Fever
Cough
Shortness of breath
Sore throat
Fatigue
Muscle or body aches
Loss of taste or smell
Other (please specify): _________________________
Temperature Check:
Temperature within normal range (below 100.4°F or 38°C)
Temperature elevated (above 100.4°F or 38°C)
Recent Travel History:
No recent travel (last 14 days)
Traveled to areas with known COVID-19 cases (please specify):
Contact with Confirmed COVID-19 Cases:
No known contact with confirmed COVID-19 cases
Known contact with confirmed COVID-19 cases (please specify):
Additional Comments or Notes:
Signatures:
[Employee's Name] Employee Name and Signature: Date: [Month Day, Year] | [Your Name] Supervisor/HR Representative Signature: Date: [Month Day, Year] |
Privacy Notice:
The information provided on this Health Monitoring Slip will be kept confidential and is solely for the purpose of ensuring a safe and healthy workplace. It may be shared with relevant authorities or medical professionals in compliance with applicable laws and regulations.
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