Covid-19

Self Screening Test

Please enter your Employee #

1/18

Do you have a fever and/or chills? (Temperature 37.8 degrees C / 100 degrees F or higher)

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2/18

Do you have a cough? Continuous, more than usual, whistling noise when breathing (NOT asthma, post-infectious reactive airways, COPD, or other known causes or existing conditions)

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3/18

Do you have shortness of breath? Out of breath, unable to breathe deeply (Not related to asthma or other known causes or conditions you already have)

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4/18

Do you have a sore throat? (Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have)

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5/18

Do you have difficulty swallowing or painful swallowing? (Not related to other known causes or conditions you already have)

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6/18

Do you have a runny, stuffy/congested nose? (Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have)

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7/18

Do you have a decrease or loss of taste or smell? (Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have)

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8/18

Do you have Pink Eye / Conjunctivitis? (Not related to reoccurring styes or other known causes or conditions you already have)

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9/18

Do you have a headache? Unusual, long-lasting (Not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have)

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10/18

Do you have digestive issues like nausea/vomiting, diarrhea, stomach pain? (Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have)

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11/18

Do you have muscle aches? Unusual, long-lasting? (Not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have)

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12/18

Are you experiencing extreme tiredness? Unusual fatigue, lack of energy (Not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

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13/18

Are you falling down often? (For older people)

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14/18

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

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15/18

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

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16/18

In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?

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17/18

In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?

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18/18

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

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Thank you for your submission

You may proceed to enter the workplace now!

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