Q01
メッセージ
すべてのテンプレートIndustry-Specific
COVID-19 Daily Health Pre-Screen Questionnaire
A pre-shift or pre-visit health screening for workplaces, clinics, and event venues that checks symptoms, exposure risk, and testing status before entry. An AI follow-up interview clarifies ambiguous or borderline symptom answers so staff can make a fast, consistent go/no-go decision.
設問の例
テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。
全11問・約6分
Q02
自由回答（短文）必須
What is your full name?
Q03
日付必須
What is today's date?
Q04
選択式必須
In the last 24 hours, have you experienced any of the following symptoms? (Select all that apply)
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Sore throat
- Loss of taste or smell
- Runny nose or congestion
- Fatigue or body aches
- Nausea, vomiting, or diarrhea
Q05
選択式必須
In the last 10 days, have you tested positive for COVID-19?
- Yes, and I am still within my isolation period
- Yes, but my isolation period has ended
- No
- I have not been tested
Q06
選択式必須
In the last 10 days, have you had close contact with someone who tested positive for COVID-19?
- Yes
- No
- Not sure
Q07
オピニオンスケール必須
Overall, how would you rate your general health today?
スケール: 1 – 5
最小:Very poor最大:Excellent
Q08
選択式
Have you taken a temperature reading today?
- Yes, below 100.4°F (38°C)
- Yes, 100.4°F (38°C) or above
- No
Q09
AIインタビュー
If the respondent reported any symptoms, a positive test within the isolation period, or recent close contact, probe for specifics: which symptoms, when they started, whether they've improved or worsened, and whether they've taken any medication that could be masking a fever. If answers suggest they should not be on-site (active symptoms, unresolved isolation, or close contact within 10 days), state that clearly and note it for staff review. If the respondent reports no symptoms and no exposure, keep this brief and confirm there's nothing else notable.
Q10
同意必須
Please confirm the statement below before proceeding.
Q11
メッセージ
Thanks for checking in! Your responses are reviewed by on-site staff to help decide next steps, and are kept confidential and used only for health and safety purposes.
含まれる機能
AIによる深掘り
自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。
注意確認設問
急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。
AIが作成する設問文
文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。
自動レポート
回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。
他ツールとの比較
ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。
このテンプレートを選ぶ理由
- Combines the standard symptom, exposure, test-status, and temperature questions with an AI follow-up interview that automatically clarifies ambiguous or borderline symptom answers so staff reach a fast, consistent go/no-go decision — something a static form cannot do.
- Includes an explicit consent step built into the flow before the respondent can proceed, keeping the compliance record self-contained.
- Auto-generates a report for on-site staff review, reducing manual triage of free-text or inconsistent answers.
- Uses chat-style welcome and closing messages to keep the daily check-in fast and low-friction for repeat use before every shift or visit.
Jotform
COVID-19 Daily Health Screening Form TemplateA ready-to-field static form covering symptoms, exposure, and temperature checks, built on Jotform's drag-and-drop form builder. It's easy to deploy and customize with Jotform's wider ecosystem of integrations, but it functions as a fixed questionnaire rather than an interactive screening interview.
優れている点
- Fielding-ready template within a mature, widely-used form builder
- Easy to customize fields and branding via drag-and-drop editor
- Likely integrates with Jotform's broader suite (notifications, storage, e-signature)
物足りない点
- No adaptive follow-up questioning to clarify vague or borderline symptom responses
- No automated quality scoring of individual responses
- No published methodology or transparent prompt logic since there are no AI-driven questions
SurveySparrow
COVID Screening Questionnaire TemplateA fielding-ready, conversational-style survey template for daily COVID pre-screening, benefiting from SurveySparrow's chat-like question flow that feels more personable than a traditional form. It still delivers a fixed question sequence rather than dynamically probing uncertain answers.
優れている点
- Conversational one-question-at-a-time format for a friendlier check-in feel
- Fielding-ready template designed specifically for COVID pre-screening
- Likely mobile-friendly given SurveySparrow's chat-style UI focus
物足りない点
- No adaptive AI interview to follow up on ambiguous symptom or exposure answers
- No automated per-response quality scoring
- No option for a voice-based interview component
QuestionPro
Workplace Health and Safety QuestionnaireThis is a general workplace health and safety questionnaire rather than a template purpose-built for daily COVID-style pre-screening, so it's broader in scope and would need adaptation for a fast pre-shift go/no-go check. It's fielding-ready within QuestionPro's survey platform but not tailored to symptom/exposure triage specifically.
優れている点
- Backed by QuestionPro's established enterprise survey platform and reporting tools
- Covers broader workplace safety topics beyond just infectious-disease screening
- Fielding-ready and customizable within their survey builder
物足りない点
- Not purpose-built for daily symptom/exposure pre-screening, requiring rework for that specific use case
- No adaptive AI follow-up to clarify borderline health responses
- No automated quality scoring or auto-generated go/no-go style reports
よくあるご質問
「COVID-19 Daily Health Pre-Screen Questionnaire」テンプレートにはどのような設問が含まれていますか？
すぐに使える設問が11問含まれており、最初の設問は次のとおりです：「Welcome! Before you head in today, please complete this quick health check-in. It takes about 7 minutes and helps keep e…」・「What is your full name?」・「What is today's date?」。すべての設問は上でプレビューでき、自由に編集できます。
このアンケートの回答にはどのくらい時間がかかりますか？
回答者は通常、11問を約6分で回答し終えます。
テンプレートは編集できますか？
はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。
このテンプレートは無料で使えますか？
はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。
公開の準備はできましたか？
このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。
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