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City of Orem
COVID-19 Employee Screening

Date & Time of Screening (Time is 24hr Clock, ex: 2pm = 14:00)

Date Picker

Unfit for Work Symptoms (CDC Requirements)

Fever of 100.4 F or higher

Shortness of Breath

Dry Cough

Possible COVID-19 Symptoms (CDC Recommends Monitoring)


Sore Throat

Runny / Stuffy Nose


Cleared to Enter Facilities / Report for Duty

Supervisor Signature

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If the department member shows any of the unfit for work symptoms they are unable to work and the employee can return to work according to the following CDC guidelines:

COVID-19 Symptoms, but no COVID-19 test

3 days (72 hours) since recovery, which is defined as:

  • Resolution of fever without fever-reducing medication and
  • Improved respiratory symptoms (cough and shortness of breath) and
  •  At least 7 days have passed since the first onset of symptoms.

COVID-19 Positive and HAVE symptoms:

  1. Resolution of fever without the use of fever-reducing medications and
  2. Improvement in respiratory symptoms (e.g., cough, shortless of breath) and
  3. Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected more than 24 hours apart.

COVID-19 Positive Test, but have shown NO symptoms

  1. It has been at least 7 days since the positive test and
  2. With no other subsequent illness.