Daily Staff Health & Wellness Check

Staff Name

Role / Position

Temp (°f/°c)

Symptoms (Tick All That Apply)

Hand/Skin Check

Wellness Status

Action Taken

Staff Initials

Manager Initials

E.G. Jane Doe

Line Cook

98.6°f / 37°c

□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore (Bandage + Glove Required)

□ Fit For Duty □ Limited Duty □ Sent Home

E.G. Assigned To Dishwashing Only

Jd

Mt

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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□ Fever □ Cough □ Vomiting □ Diarrhea □ Sore Throat □ Fatigue □ Jaundice □ None

□ Clear □ Cut/Sore

□ Fit For Duty □ Limited Duty □ Sent Home

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Question

Yes

No

Notes / Details

1. Do You Have Or Have You Recently Had A Fever (above 37.8 °C / 100°f)?

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2. Have You Experienced Vomiting Or Diarrhea In The Past 48 Hours?

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3. Do You Currently Have A Sore Throat, Persistent Cough, Or Runny Nose?

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4. Have You Been Diagnosed With, Or Are Awaiting Results For, A Contagious Illness (E.G., Norovirus, Flu, Covid-19, Hepatitis A)?

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5. Have You Had Close Contact With A Confirmed Case Of A Contagious Illness In The Past 5 Days?

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6. Have You Taken Any Medication Today For Fever, Nausea, Pain, Or Diarrhea?

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7. Do You Have Any Open Cuts, Wounds, Burns, Or Infected Sores On Your Hands, Wrists, Or Arms?

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Bandage + Glove Required Before Handling Food

8. Are You Feeling Unusually Fatigued, Dizzy, Or Unwell Beyond Normal Tiredness?

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9. Are You Experiencing Significant Stress, Anxiety, Or A Personal Situation Affecting Your Focus Or Safety At Work Today?

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Manager To Follow Up Privately If Needed

10. Is There Anything Else Affecting Your Ability To Perform Your Duties Safely Today?

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Symptom / Condition

Required Action

Return-To-Work Criteria

Fever (>37.8°c / 100°f)

Remove From Duty Immediately. Isolate From Food Handling And Other Staff.

Symptom-Free For A Minimum Of 24–48 Hours Without Fever-Reducing Medication (Follow Local Health Code).

Vomiting Or Diarrhea

Send Home Immediately. Do Not Allow Near Food Prep, Service, Or Dishwashing Areas.

Symptom-Free For At Least 48 Hours. Medical Clearance May Be Required.

Diagnosed With Norovirus, Hepatitis A, Salmonella, Or Similar Food-Borne Illness

Exclude From Work Entirely. Notify Local Health Authority If Required.

Medical Clearance And Written Approval from the Health Authority Required Before Return.

Jaundice (Yellowing Of Skin Or Eyes)

Exclude From Work Immediately. Potential Indicator Of Hepatitis A.

Medical Clearance Required Before Return.

Sore Throat With Fever

Send Home.

Symptom-Free For 24–48 Hours Or Medical Clearance Obtained.

Sore Throat Or Cough Without Fever

Allow Masked, Limited Duty Away From Open Food And Direct Customer Contact. Monitor Throughout Shift.

Symptoms Resolved Or Medical Clearance Provided.

Open Cut, Wound, Or Burn On Hands/Arms

Cover With A Waterproof, Brightly Coloured Bandage And Wear Single-Use Gloves Before Handling Food.

Wound Healed Or Fully Covered And Cleared By Manager.

Unusual Fatigue Or Dizziness

Assign To Non-Safety-Critical Tasks (E.G., Stocking, Cleaning). Monitor For Deterioration.

Staff Member Reports Feeling Recovered.

Mental Health / Personal Stress Concern

Manager To Speak Privately. Offer Support, Adjust Duties If Needed. Consider Referral To Eap (Employee Assistance Programme) If Available.

Staff Member Confirms Ability To Work Safely.

Medication Taken For Fever, Nausea, Or Diarrhea

Treat As Potentially Symptomatic. Restrict Food Handling Duties Until Assessed By Manager.

Confirmed Symptom Resolution Without Ongoing Medication Reliance.

Date

Staff Name

Reason For Exclusion / Action

Date Cleared To Return

Manager Signature

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