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Coronavirus Self Declaration Form
About this template
A coronavirus self-declaration form is used by individuals infected with COVID-19 to report their medical status. Whether you’re an employer or manage HR for a company, this free Coronavirus Self-Declaration Form allows members of your staff to confirm if they have coronavirus, so they can proceed to seek medical treatment and prevent further contamination in your workplace. Employees can provide their contact details, describe their recent travel history, list people they have come into contact with, and check off any symptoms they may be experiencing.
To keep your employees’ sensitive medical information as safe as possible, Jotform offers a HIPAA compliance option. If you’d like to make any adjustments to this readymade Coronavirus Self-Declaration Form, our drag-and-drop Form Builder lets you easily add form fields, conditional logic, images, and more to create a form that perfectly suits your needs. You can even integrate with 100+ popular apps to organize submissions in the other accounts you rely on. With our free Coronavirus Self-Declaration Form, you’ll be able to take the proper precautions and keep you and your employees safe during this pandemic.
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