Health Screening Form Template

About

The Health Screening Form Template is designed to help organizations collect essential health-related information in a secure and efficient manner. Whether you're screening employees before they enter a workplace, assessing patients ahead of appointments, or managing event safety, this form streamlines the intake process. With customizable fields for symptoms, travel history, and contact information, it ensures a clear picture of each respondent’s health status. It's easy to complete, mobile-optimized, and helps you meet public health guidelines without sacrificing user experience.  

Key Features of Our Health Screening Form Template:

1. Collect Essential Screening Information

1. Full Name (text): Records the respondent’s name for identification and record-keeping.

2. Phone Number (phone): Allows for quick contact if follow-up is necessary based on responses.

3. Email Address (email): Offers an alternative way to send confirmations or additional instructions.

4. Date of Screening (date): Automatically captures when the screening was completed for traceability.

5. Recent Symptoms (checkbox): Users can select symptoms such as fever, cough, or fatigue, allowing quick assessment of risk.

6. Recent Travel (textarea): Respondents can provide details on recent travel history that may impact health protocols.

7. Exposure Confirmation (radio): A simple yes/no option to indicate if the person has had recent contact with a confirmed case of illness.

2. Improves Workplace and Event Safety

1. This form helps reduce the risk of infectious disease transmission by identifying individuals who may need further evaluation or should avoid entering certain spaces.

3. Adapts to Health Guidelines

1. As public health requirements evolve, this template can easily be updated to reflect the latest safety measures, keeping your organization compliant.

4. Encourages Honest, Private Disclosure

1. All information collected remains confidential, which encourages respondents to provide accurate and honest answers.

5. Real-Time Notifications and Easy Review

1. Once submitted, you can receive instant alerts and review responses in your dashboard or export them for secure documentation and analysis.

How to Use the Health Screening Form Template

1. 1. Import the template: Log into your Likeable Forms account, navigate to Templates, and import the Health Screening Form Template.

2. 2. Customize Your Fields: Tailor field labels and descriptions to reflect the health concerns relevant to your organization or event.

3. 3. Add Instructions or Warnings: Include instructions for what users should do if they report symptoms or recent exposure.

4. 4. Enable Alerts: Set up notifications so your team is informed when responses require urgent attention.

5. 5. Publish and Distribute: Share the form link with staff, patients, or attendees before entry or via appointment reminders.

Keep Your Environment Safe with Smart Health Screening

The Health Screening Form Template is a practical tool that supports proactive health management. Whether for business, healthcare, or events, it enables safer environments and informed decision-making with minimal setup required.  

Looking for a simple way to collect health data and stay compliant? Our online form creator makes it easy to build, share, and manage secure health screening forms in minutes.