Background The scale of the COVID-19 pandemic has required rapid development of both governmental and institutional policies and protocols to minimize transmission. We describe our institution's implementation of a symptom monitoring program with this goal. Methods We developed a symptom monitoring tool based on our return-to-work guidelines using a Qualtrics survey tool. We implemented this for healthcare workers (HCWs) and provided individualized real time guidance and linkage to COVID-19 testing if indicated. Results During the period from April 2nd to April 17th, 2020, 9446 HCWs had enrolled in the symptom tracking survey, with 5,035 HCWs completing the survey daily at the end of this period. 1,318 HCWs had been identified as being symptomatic with an indication for SARS-CoV-2 testing and were directed to the hotline to have this ordered. Of these, 82% reported not currently staying home from work due to illness or quarantine when first reporting symptoms. Discussion and Conclusions A survey based symptom monitoring tool can be rapidly designed and implemented, and incorporated with a testing strategy. Our results show the potential for quick uptake, and effectiveness in identifying and addressing presenteeism. We report our large academic institution's experience as a model to be adapted for use in this and future pandemics.