Employee or Trade Name
Company Name

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.

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.