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San Francisco Department of Public Health 

Personnel Screening Questions

- download official form here -

Personnel at businesses and other entities operating during the COVID-19 pandemic MUST answer these questions before starting work every day, either in person or online. Personnel MUST stay out of work for the appropriate amount of time if they answer YES to any of the questions.


If you answer YES to any of the screening questions, do NOT enter the location:

• Stay at home, except to get tested or get needed medical care;

Follow the steps mandated by Health Directive 2020-02/03 and explained at:

Note: If you have recovered from COVID-19 in the last three months, speak with your health provider to determine whether you should stay home from work, regardless of how you answer the screening questions. Regardless of vaccination or previous COVID-19, Cal/OSHA ETS may require staying out of work longer if Close Contact1 was in the workplace.

Question #1: In the last 24 hours, including today, have you had ANY of the symptoms below, that is new or not explained by another condition?
Question #2: In the past 10 days, have you been diagnosed with COVID-19 or had a test confirming you have the virus?
Question #3: In the past 10-14 days, have you had “close contact” with anyone who has COVID-19, during their contagious period?

(Please note: If you have received the COVID-19 vaccine, see If you do not need to quarantine based on what is explained there, for the purposes of this screening form, you may answer “No” to this question.)

Thanks for submitting!

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