COVID-19 Self-Screening Checklist

Self-Screening Health Checklist for Widespread Virus

To help protect Interlink's employees and visitors against the spread of Covid-19, each employee and visitor is required before entering our facilities to fill out a self-screen to claim they are healthy and have not been exposed to Covid-19

  • 1.) Each visitor must take their own temperature and submit this completed self-screen checklist each day before coming into customer locations

  • 2.) In the past 24 hours, have you experienced any of the following:

  • Has someone in your household or someone you have been in close contact with tested positive for COVID-19
    (close contact with an infected person means within 6 ft for 10 minutes or more)
  • IF YOU ANSWER “YES” TO ANY OF THE ABOVE, PLEASE STAY HOME.

  • 3.) In the past 24 hours, have you experienced:

  • IF YOU ANSWER “YES’ TO ANY OF THE QUESTIONS IN SECTION 3 ABOVE, PLEASE WEAR A FACE MASK AT ALL TIMES TO PREVENT THE SPREAD OF ANY ILLNESS.

  • 4.) Consent

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.