CAMC Employee Health Screening Form

CAMC has developed a Google Form template to facilitate data entry and recording when performing mandatory employee health screening as required by the Ingham County March 27, 2020 Public Health Order. The form can be used with any PC, tablet or mobile device connected to the Internet. The data entered into the form is saved in a linked Google Sheet with an automatic date/time-stamp for each entry.


To use the form for your company’s mandatory employee health screening, you must have a Google G-Suite account, which requires an upgrade from a standard free Google account.  More information on creating a G-Suite account can be found here. The CAMC Employee Health Screening (EHS) template can then be copied to your account.


Once it is live on your G-Suite account, entered data will be stored in the associated Google Sheet. Data recorded in the Sheet can be downloaded and saved as an Excel/CSV file or other formats (PDF, etc). The Sheet can also be sorted by employee number (or name) to organize the daily screening data for each employee, which can then be downloaded separately if desired.


Access to the form can be limited only to designated employees who have administrative privileges to your G-Suite account or to anyone with the link to the form. Providing access to the form through a link does not provide access to the data stored in the associated Google Sheet.


If you have an IT team or consultant, they may be able to create a more sophisticated form that automatically populates the first and last name fields based on entering an employee ID number to speed data entry. You can also easily modify the CAMC EHS template to add or remove fields based on your specific needs.


Please note that the CAMC EHS form captures and saves the responses to the screening questions and the temperature data entered each time an employee is screened. The ICHD recommends but does not require you to retain this data.

In addition, because some of the data collected through this form may be considered confidential medical information under HIPAA, we recommend that you limit access to the data saved in the Sheet to authorized personnel.

The CAMC EHS form is provided as a quick, turnkey solution to complying with the ICHD emergency order by facilitating rapid employee health screening and data entry using a PC, tablet or mobile device instead of filling out paper forms. The form can be used by company personnel responsible for screening employees as they enter a facility or for employee self-reporting.

To test drive the CAMC EHS Form, please click here. To preview sample data stored in the Google Sheet, please click here.

For technical assistance with installing the CAMC EHS Form and related Sheet on your G-Suite account, please send an email to with your contact information and we will get back to you promptly.


Below is an updated link to the Public Health Order, which you are required to post at the entry points to your workplace:

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Lansing, MI 48915

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