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Covid-19 Screening
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Covid-19 Screening
Email
Employee or Trade Name
*
Employee or Trade Name
Job Site
*
Email Address
*
Company
*
Company Name
Today's Date
*
Required Screening Questions
Do you have
any of the following new or worsening symptoms or signs
?
Symptoms should not be chronic or related to other known causes or conditions.
Fever or Chills
*
Yes
No
Difficulty breathing or shortness of breath
*
Yes
No
Cough
*
Yes
No
Sore throat, trouble swallowing
*
Yes
No
Runny nose/stuffy nose or nasal congestion
*
Yes
No
Decrease or loss of smell or taste
*
Yes
No
Nausea, vomiting, diarrhea, abdominal pain
*
Yes
No
Not feeling well, extreme tiredness, sore muscles
*
Yes
No
2. Have you travelled outside of Canada in the past 14 days?
*
Yes
No
3. Have you had close contact with a confirmed or probable case of COVID-19?
*
Yes
No
Results of Screening Questions:
If the individual answers NO to all questions from 1 through 3, they have passed and can enter the workplace.
If the individual answers YES to any questions from 1 through 3, they have not passed and should be advised that they should not enter the workplace (including any outdoor, or partially outdoor, workplaces). They should go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1- 866-797-0000) to find out if they need a COVID-19 test.
