Twitter Employee or Trade Name * Employee or Trade Name Email Address * Company * Company Name Today's Date * Required Screening Questions 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 * Yes No Difficulty breathing or shortness of breath * Yes No Cough * Yes No Sore throat, trouble swallowing * Yes No Runny nose/stuffy nose or nasal congestion * Yes No Decrease or loss of smell or taste * Yes No Nausea, vomiting, diarrhea, abdominal pain * Yes No Not feeling well, extreme tiredness, sore muscles * Yes No 2. Have you travelled outside of Canada in the past 14 days? * Yes No 3. Have you had close contact with a confirmed or probable case of COVID-19? * Yes No Results of Screening Questions: If the individual answers NO to all questions from 1 through 3, they have passed and can enter the workplace. If the individual answers YES to any questions from 1 through 3, they have not passed and should be advised that they should not enter the workplace (including any outdoor, or partially outdoor, workplaces). They should go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1- 866-797-0000) to find out if they need a COVID-19 test.
