Return-to-Workplace: Entry Screening Requirements: Symptom Checkers and Temperature Checks

As employers the world over look to return employees to the worksite, there are dozens of steps to consider to mitigate the potential risk of COVID-19 infection and support the overall well-being of the workforce.

Employers should be prepared to address several aspects of a safe return to work strategy, including decisions on who should return to work and when, procurement of personal protective equipment, worksite readiness, and how to communicate these changes to employees and their families.

As companies begin bringing employees back to the workplace, providing a safe and healthy environment is their primary focus. Entry protocols for worksites can include screening procedures such as: temperature checks, symptom checkers and testing. The specific components that are implemented, guidelines, thresholds and method of administration can vary. Employers consider several factors when choosing the approach that is right for their company.

Temperature Checks

Worldwide, temperature checks are a common entry requirement. According to Business Group on Health’s May survey, “Large Employer Response to Coronavirus,” 61% of respondents have implemented daily temperature checks for employees.

Method

Employers’ approaches to temperature checks may vary considerably. Options include:

  • Home Check:

    Employees are asked to check their temperature at home each day before coming into the workplace. Only those below the acceptable temperature threshold (see “Guidelines” for more information about thresholds) are permitted to report to the workplace. Business Group on Health’s May survey found that 28% of respondents reported having a home check procedure.

  • On-site check:
    • Internal personnel: Some companies are having internal staff (such as security, health and safety or medical personnel) or contracted staff of trained health professionals conduct temperature checks using no-contact thermometers. Survey results showed that 68% of respondents have internal staff administer the temperature checks.
    • Vendor Assisted: The Business Group’s May survey found that 32% of respondents are using an external vendor for temperature checks. While solutions vary, some include access to a live nurse through an app. The individual takes their temperature using their own thermometer and shows the result to the nurse, who is online.
    • Thermal Scanners: Used by some companies in larger locations, these scanners must be monitored to ensure that only those with a reading below the threshold can gain entry. Complications can arise in warmer weather or hotter climates, as those impacted by the weather can be identified by the scanner as potentially having a fever.

Some companies that have implemented a home check approach, have decided to reimburse employees for their thermometer purchase, or provide them in “Welcome Kits” that may include RTW materials, such as a thermometer, mask, hand sanitizer, entry procedures and related resources.

Guidelines

Determining what temperature constitutes a fever for purposes of entry protocols is not necessarily obvious. Guidance has changed during the course of the pandemic, and different organizations suggest different thresholds. Many companies have decided to use the current Centers for Disease Control and Prevention (CDC) guidance of 100.4°F. Other companies have opted to use the World Health Organization (WHO’s) guidance of 99.1 °F. For employers with a global workforce, using the WHO threshold allows them to have a consistent approach for all employees across countries. Other companies have opted to be more conservative and are using an even lower threshold for fever.

For example, depending on the location, a temperature check protocol may need to be created after consultation with labor representatives, such as unions or works councils, or employee consent may be needed. In other countries, performing temperature screening procedures may be required.

Consult with your labor department and legal counsel regarding local laws applicable to temperature checks. In some countries, certain requirements govern whether or how an employer can implement temperature checks.

Symptom Checkers

Temperature checks screen for fever. However, fever is just one of a many of symptoms that could present for those with COVID-19, the disease caused by the novel coronavirus. For this reason, many companies are requiring assessments or questionnaires, often referred to as symptom checkers, to be completed by employees prior to their entry to the workplace. According to Business Group on Health’s May survey, 51% of large employers require employees to complete a symptom checker before reporting to the workplace.

Here are some of the considerations when deciding on a tool to use as a symptom checker:

  • On-site Assessment: Some companies are implementing a live assessment. In this format, internal or contracted staff (for example, security, nurse, or a member of the environment, health and safety team) ask employees whether they have had certain symptoms.
  • Self-assessment: In other companies, employees conduct a self-assessment questionnaire that asks about certain symptoms. Often these are online questionnaires or apps. Upon completion, the assessment advises whether the employee is approved to report to the workplace that day. Upon arrival, personnel at the entry point may ask the individual to confirm they have clearance from the daily assessment. This could involve a verbal or written acknowledgment from the employee. Some apps display a “green” (meaning cleared for workplace entry) or “red” (not cleared to enter the workplace) result. To gain entry, employees must display their “green” badge, which is date stamped.
  • In-house vs Vendor vs Public Resources: Some companies decided to build their own assessment tool in-house. Other companies have opted to use an external vendor. By partnering with an external vendor, a company can still customize the questions based on its screening preference while also leveraging other data sources for inclusion in the app. For example, some vendors can integrate with a company’s well-being portal or internal policies or resources, as well as community data such as prevalence of cases. Depending on the tool, some are available in multiple languages and can be adapted for local requirements that may vary by country. There are also some publicly available online symptom checkers, such as those available from the CDC and John Hopkins.
  • Questions to Include: Deciding what questions or symptoms to screen for in the assessment is key. Many companies choose to use the CDC listing of COVID-19 symptoms. However, other companies have decided to expand the list to include other symptoms, as the CDC listing does not include all possible symptoms. Using symptoms listed by the WHO or local health departments are also possibilities.

The current list of CDC symptoms includes:

  • Fever or chills;
  • Cough;
  • Shortness of breath or difficulty breathing;
  • Fatigue;
  • Muscle or body aches;
  • Headache;
  • New loss of taste or smell;
  • Sore throat;
  • Congestion or runny nose;
  • Nausea or vomiting; and
  • Diarrhea.

The WHO classifies symptoms as follows:

Most common symptoms:

  • Fever;
  • Dry cough; and
  • Tiredness.

Less common symptoms:

  • Aches and pains;
  • Sore throat;
  • Diarrhea;
  • Conjunctivitis;
  • Headache;
  • Loss of taste or smell; and
  • A rash on skin, or discolouration of fingers or toes.

Serious symptoms:

  • Difficulty breathing or shortness of breath;
  • Chest pain or pressure; and
  • Loss of speech or movement.

For reference, see the WHO's Coronavirus page.

In addition to questions related to symptoms, the assessment could also include questions about whether the individual has been in contact with someone who has tested positive for the virus.

Learn More

What to Do When Someone Is Symptomatic at Screening

For many companies, entry protocols such as temperature checks and symptom checker assessments are a daily process. If someone presents with a temperature above the prescribed company guideline or does not pass the symptom checker assessment, it is important that there are clear and immediate instructions explaining what the employee should do next. For example, the employee will be advised not to return the workplace until they are symptom free for a specific period of time and/or can present a negative test result. The employee should also be advised to work from home, their health permitting, or if they are in a role or job function in which they are unable to work from home, they should be advised of any leave policy that applies.

In addition to the employee being told that they are not permitted to enter the workplace, depending on the symptoms presenting, they may likely be recommended for testing. Some companies may facilitate testing for employees identified as symptomatic during the screening process; however currently, most companies are referring such employees to the health system for testing. While most testing is used for diagnostic purposes (for those who are displaying symptoms or have had contact with someone who tested positive for the virus), testing can also be considered as another component of screening if it is provided to both symptomatic and asymptomatic individuals. Whatever route employers choose to take, their role in testing has its own unique set of challenges. See the testing section for more details on testing considerations.

Adhering to privacy requirements is crucial. Whether administering temperature checks or monitoring symptom checker assessments, it is important to understand the local privacy laws. Some companies are navigating this by ensuring that any discussions with employees are in a private area that cannot be overheard by others. When monitoring occurs, no record is kept of individual results, such as temperatures.

Acknowledging Limitations

Even when implemented in the most rigorous possible way, temperature checks and symptom checker assessments are only identifying symptomatic individuals. If a company enforces a clear sick policy mandating that employees do not come to the workplace when they are ill, employees should stay home when symptomatic. Constant monitoring for symptoms, including encouraging employees to come forward if they start to feel ill while at work, is important. According to health experts, because a significant percent (40% or more) of the spread of the virus is attributed to asymptomatic individuals (those infected with the virus who do not develop symptoms) and pre-symptomatic individuals (those infected with the virus who have not yet developed symptoms but will do so later), some people who are infected, and can spread the virus to others, will not be identified with these approaches. Therefore, these procedures cannot be relied upon alone. Workplace readiness protocols (discussed in a subsequent section of this guide) such as physical distancing, limiting elevator and common room access, cleaning procedures and PPE (personal protective equipment), are a fundamental part of a holistic RTW strategy. Together, these strategies are the best way to mitigate the risk of viral exposure in the workplace.

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TABLE OF CONTENTS

  1. Temperature Checks
  2. Method
  3. Guidelines
  4. Symptom Checkers
  5. What to Do When Someone Is Symptomatic at Screening
  6. Acknowledging Limitations