COVID-19 Employee Screening Form

    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 *

    Have you travelled outside of Canada in the past 14 days? *

    Have you had close contact with a confirmed or probable case of COVID-19? *

    In the past 14 days have been directed by Public Health to self-isolate? *