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  • Required Screening Questions

    Please use this self-assessment tool to determine if you will be permitted entry into the workplace.

    Note: The results of this questionnaire will be delivered to your employer for their records.

    1. 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.

  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • 2. Have you travelled outside of Canada in the past 14 days?
  • YesNo
  • 3. Have you had close contact with a confirmed or probable case of COVID-19?
  • YesNo
  • This questionnaire has been adapted from Ontario Public Health Guidelines.