COVID-19 Health Self-Check Survey Template and Questionnaire

Number of pages 2 Number of questions 5 Number of times used 6290+

Time to complete 1 minutes(approx.)

In the midst of a pandemic, paranoia is one of the scariest symptoms. Make it easier for individuals to quickly assess themselves or a loved one without increasing their worry – and your workload – with our COVID self-assessment template. 

Whether you’re re-opening the office for employees or just checking in, these questions make it easy for you to keep in touch with your team and help them confidentially share any symptoms or concerns.

Targeted questions in this quick self-assessment survey help you to develop a holistic picture of your team members’ health so you can help support their needs and prioritize everyone’s safety.

We’ve kept it quick and easy with our ready-to-use COVID self-test template. Check it out: 

Prioritize Employee Safety

  • Customizable Template Customize the template to keep up with the latest concerns and streamline the experience for your team members by pre-populating known information. Make the check-in as easy as possible to help participants with an effortless self-assessment test and reduce the panic behind the pandemic.  The COVID self-test includes critical questions that can help participants determine next steps. 
  • Automated Follow-Up  Once the questions are answered, what’s next? Results might show that the individual should be tested immediately, or perhaps they should simply stay home. Let participants know what their results show and what next steps are suggested by showing a post-participation page or even sending a follow-up email based on the appropriate conditions. Avoid further anxiety and guessing by helping participants to get the right guidance for what to do next. It's a great way to abate the uncertainty of the pandemic while helping to keep your team healthy and protect the safety of your workplace.
  • Top Security Compliances When you’re handling medical information, you can never be too careful. That’s why Sogolytics adheres to top global security compliances. We take our clients’ security and confidentiality very seriously and believe that any information shared with you is yours alone. Collect and use the sensitive data you need, confident in the knowledge that security is one of our core values.


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