Daily COVID19 Screening

EMPLOYEE COVID19 DAILY SCREENING

Your Name (required)

Do you have any of the following new or worsening symptoms of signs? (required)
NONEFever or chillsDifficulty breathing or shortness of breathCoughSore Throat, trouble swallowingRunny nose/stuffy noseLoss of smell/tasteNausea/vomitingNot feeling well, extreme tiredness
Have you travelled outside of Canada in the past 14 days? (required)
NoYes
Have you had close contact with a confirmed or probable case of COVID19? (required)
NoYes
I understand I am responsible for - Please check to confirm: (required)
Practicing physical distancing of 2 meters from other employees or visitors in the workplaceWearing a face covering when physical distancing cannot be maintained