COVID-19 STAFF SCREENING

    Department*:
    Employee Name*:

    Do you have any of the following symptoms or signs (not related to recently administered Covid Vaccine)?

    • Severe difficulty breathing (struggling for each breath, can only speak in single words)
    • Severe chest pain (constant tightness or crushing sensation)
    • Feeling confused or unsure of where you are
    • Losing consciousness
    • Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius or higher)
    • Chills
    • Cough that's new or worsening (continuous, more than usual)
    • Barking cough, making a whistling noise when breathing (croup)
    • Shortness of breath (out of breath, unable to breathe deeply)
    • Sore throat
    • Difficulty swallowing
    • Runny nose (not related to seasonal allergies or other known causes or conditions)
    • Stuffy or congested nose (not related to seasonal allergies or other known causes or conditions)
    • Lost sense of taste or smell
    • Pink eye (conjunctivitis)
    • Headache that's unusual or long lasting
    • Digestive issues (nausea/vomiting, diarrhea, stomach pain)
    • Muscle Aches
    • Extreme tiredness that is unusual (fatigue, lack of energy)
    • Falling down often

    In the last 5 days, have you been in close physical contact with someone who tested positive for COVID-19?
    Close phyiscal contact means:

    • being less than 2 meters away in the same room, workspace, or area for over 15 minutes
    • living in the same home

    In the last 5 days, have you been in close physical contact with a person who either:

    • is currently sick with a new cough, fever or difficulty breathing?
    • returned from outside of Canada in the last 2 weeks and has been advised to quarantine per the federal quarantine requirements?

    In the last 10 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?

    Answer - If the answer is yes to any of the above questions, indicate yes below. *

    YesNo



    * If you check YES, please contact your manager for confirmation to arrive to work.