Back To Work | Couch & Associates

Customize your site!

Branding

*Company Name:

Company Logo Url (ideally 140 x 140):

Primary Color:

Accent Color:

Site Access

Provide easy access to your screening site with a Scannable QR Code. Place the code on a poster outside your workplace requesting employees and visitors to screen before entering.

Download QR Code

Admin Contact

First Name:

Last Name:

Phone Number:

Email Address:

Advanced

Language: Please note the free site is currently offered in English only. Please contact us for more information, or to discuss customizing your site.

Who is this site being used for? Your site's experience will be updated to use the above language. For example, “Employee” Screening Tool, or “Student” Screening Tool.

Include announcement when users access the site?

Fail badge message:

Integration & Reporting

Have Users Select Their Location Please list your locations separated by a comma.

Have users identify themselves? Provide the label you want to display for your identifier field.

Google Sheets Integration Watch the set up How-To Video 🡽.

Integrating with your Google account lets you view and own the submission data. Visit this link 🡽 to copy the Google Form, then follow the instructions provided to create a “pre-filled link” to input below. By enabling this feature, you take full responsibility for the management of any personal and/or sensitive data based on your specific regional rules and guidelines.

Integrate with:

School Name:

School Outbreak Number:

Activate Integration Please contact us ✉ for help with this integration.

Advanced Routing

Route Type 1:

Route URL 1:

Route Type 2:

Route URL 2:

Disclaimer

This tool provides basic information only and contains recommendations for businesses or organizations for COVID-19 screening. It is not to be used as a clinical assessment tool or intended to take the place of medical advice, diagnosis or treatment. Where the tool includes references to legal requirements, it is not to be construed as legal advice. Screening should occur before or when a worker enters the workplace at the beginning of their day or shift, or when an essential visitor arrives. Please follow all local guidelines and recommendations. This application may not be applicable to all workplace settings, and may be adapted based on need and the specific setting.

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The screening site has not been registered.

Please fill out the Get Screening form or contact your team's admin.

Your site is ready!

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Share Go to my Site

If you wish to later edit your screening site’s details, simply click the same “Customize My Site” button in the setup email.

We can customize your solution with advanced features at any time, contact us for more information.