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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.

    For individuals who are 18 years of age and older:

  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • 2. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
  • YesNo
  • 3. In the last 10 days, have you tested positive on a rapid antigen test or a homebased self-testing kit?
  • YesNo
  • 4. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?
  • YesNo
  • 5. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
  • YesNo
  • 6. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?
  • YesNo
  • 7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
  • YesNo
  • This questionnaire has been adapted from Ontario Public Health Guidelines.