Employee Information
Preferred Language
First Name
Last Name
 
 
Badge ID
Location
 
 
Required Screening Questions
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.
Fever or chills
 
Difficulty breathing or shortness of breath
 
Cough
 
Sore throat, trouble swallowing
 
Runny nose/stuffy nose or nasal congestion
 
Decrease or loss of smell or taste
 
Nausea, vomiting, diarrhea, abdominal pain
 
Not feeling well, extreme tiredness, sore muscles
 
2. Have you travelled outside of Canada in the past 14 days?
 
3. Have you had close contact with a confirmed or probable case of COVID-19?