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Coronavirus (COVID-19): Self-Certification Prior to Shift Form

Author: XpertHR Editorial Team

When to Use

In order to minimize the risk of exposure to COVID-19, an employer may wish to have employees complete a self-certification form prior to the start of each work shift that has the employee certifying that they:

  • Do not have symptoms of COVID-19;
  • Have not had close contact with an individual diagnosed or showing symptoms of COVID-19; or
  • Have not been directed to self-isolate or quarantine by their health care provider or a public health official.

An employer can use this form to provide to employees prior to each shift.

Customizable Form