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  1. Home
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  3. Self Assessment
  4. COVID-19 Daily Health Screening Form
Self Assessment

COVID-19 Daily Health Screening Form 2026

This seven-question form opens by asking for the respondent's full name and today's date to create a timestamped record tied to a specific person. It then checks for fever and a broad list of new or worsening symptoms — including cough, fatigue, sore throat, and new loss of taste or smell — before asking about close contact with a confirmed COVID-19 case in the last 14 days and recent travel to a high-transmission area. A final confirmation question asks respondents to attest that everything they've entered is accurate. After submitting, respondents see a thank-you screen acknowledging their contribution to a safe environment for all.

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Trusted by over 10,000 customers and growing

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Conversations Started

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Questions Answered

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Forms Created

This template is ideal for

Office and workplace managers

They rely on the "In the last 14 days, have you been in close contact with anyone confirmed to have COVID-19?" question to catch potential on-site exposure before it spreads among staff.

Schools and universities

They use the symptom checklist question to screen students and staff each morning, creating a dated record that supports attendance and health reporting.

Event and venue operators

They depend on the "Have you traveled internationally or to an area with high COVID-19 transmission in the last 14 days?" question to flag attendees who may have been exposed through recent travel.

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AI builds and refines your form through natural conversation no templates, no complex logic, no coding. From a simple text prompt or URL, Dashform generates intelligent flows that adapt automatically.

Conversations That Understand Context

Dashform turns traditional form-filling into a two-way dialogue. The AI understands intent, remembers context, and asks relevant follow-up questions just like a real human conversation.

Better Data, Better Decisions

Every response is transformed into structured, meaningful, and ready-to-use data. Integrate with your favorite tools.

Powerful features included

Everything you need to create amazing forms

Smart Field Detection
Automatically detects and suggests the best field types for your data.
Real-time Validation
Validate responses as users type with instant feedback and error messages.
Multi-device Support
Forms work seamlessly across desktop, tablet, and mobile devices.
Advanced Analytics
Track form performance with detailed analytics and response insights.

Frequently asked questions

Everything you need to know about this template

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