Employees Daily Health Reporting员工每日健康问卷（英文版）

Thanks for your cooperation!

Q1:What was the time when you are filling the form?（时间）

Morning 早晨

Afternoon 下午

Q2:工号（请自行脱敏处理，如用化名等）

填空1

Q3:Your current temperature

Normal正常(37.3℃)

Abnormal体温异常(≥37.3℃) Please specify

Q4:Did you or will you leave the company today?

NO没有离开公司

Yes and I haven’t leave.

Yes and I have returned.

Yes and I am on my way.

Q5:Your colleagues stay in the company today?

YES在

NO不在 If NO, please specify the situation.

I work alone

Q6:Do you or any of your colleagues have the following symptoms？

Fever发热（≥37.3）

Cough咳嗽

Sore throat咽痛

Chest Tightness胸闷

Difficulty in breathing呼吸困难

Mild limbs/lower back muscle soreness/weakness/poor energy轻度四肢/腰背部肌肉酸痛/乏力/精神稍差

Nausea, vomiting/diarrhea恶心呕吐/腹泻

Headache头痛

Tachycardia心慌

Others其他

None of above无以上症状

Q7:In the past 14 days, have you or your colleagues been in contact with persons who are back to the company from other cities ？

NO没有

YES有 If yes, please specify the details: person, date and Vehicle (Train No.).

Q8:In the past 14 days, have you or your colleagues travelled from medium-risk or high-risk areas to the company?

NO没有

YES有 If yes, please specify the details: person, date and Vehicle(Train No./Flight No./Car No.)

Q9:Do you have any visitors from other companies in the same city today?

NO没有

YES有 If yes, please specify the details: person, date and Vehicle(Train No./Flight No./Car No.)

Q10:当前所在办公地点（请自行脱敏处理，如用模糊地址等）

选项1

Q11:I promise I will fill the bellowing form with true and accurate information and bear the correspondent responsibilities if I was covering up.

Agree同意

Q12:What's your favorite sport?

Basketball

Football

Running

Swimming

Employees Daily Health Reporting员工每日健康问卷（英文版）

介绍

本模板旨在提供员工每日健康状况的标准化报告方案。帮助您掌握员工体温、了解症状表现、追踪接触历史，适合企业HR和管理者保障办公环境健康安全。

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Employees Daily Health Reporting员工每日健康问卷（英文版）

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