COVID-19 Employee Screening
Your personal details
First Name
Last Name
COVID-19 Screening
Do you have new or worsening symptoms or signs of fever or chills?
Yes
No
Do you have new or worsening symptoms or signs of a cough?
Yes
No
Do you have new or worsening symptoms or signs of runny nose/stuffy nose or nasal congestion?
Yes
No
Do you have new or worsening symptoms or signs of nausea, vomiting, diarrhea, abdominal pain?
Yes
No
Have you travelled outside of Canada in the past 14 days?
Yes
No
Do you have new or worsening symptoms or signs of difficulty breathing or shortness of breath?
Yes
No
Do you have new or worsening symptoms or signs of sore throat, trouble swallowing?
Yes
No
Do you have new or worsening symptoms or signs of decrease or loss of smell or taste?
Yes
No
Do you have new or worsening symptoms or signs of not feeling well, extreme tiredness, sore muscles?
Yes
No
Have you had close contact with a confirmed or probable case of COVID-19?
Yes
No
I wish to receive further information from your organization. I am aware that I may unsubscribe to such information at any time.