COVID-19 Screening for Workplace

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?*

Do you have new or worsening symptoms or signs of a cough?*

Do you have new or worsening symptoms or signs of runny nose/stuffy nose or nasal congestion?*

Do you have new or worsening symptoms or signs of nausea, vomiting, diarrhea, abdominal pain?*

Have you travelled outside of Canada in the past 14 days?*

Do you have new or worsening symptoms or signs of difficulty breathing or shortness of breath?*

Do you have new or worsening symptoms or signs of sore throat, trouble swallowing?*

Do you have new or worsening symptoms or signs of decrease or loss of smell or taste?*

Do you have new or worsening symptoms or signs of not feeling well, extreme tiredness, sore muscles?*

Have you had close contact with a confirmed or probable case of COVID-19?*

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