If you are human, leave this field blank.To keep all our employees safe, we are following local heath department recommendations and requiring that every employee be assessed for COVID-19 symptoms and risk factors each day before starting your work day.Name *Please SelectFrank ZuccaroLuciano DiMuccioMario DistauloPeter BryantShelagh Mcgarvey1. 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.Felt Feverish and/or a Documented Fever *YesNoChills *YesNoSweats *YesNoCough *YesNoShortness of Breath or Difficulty Breathing *YesNoNot Feeling Well, Extreme Tiredness, or Muscle Pain *YesNoSore Throat or Trouble Swallowing *YesNoRunny/Stuffy Nose or Nasal Congestion *YesNoNew Loss of Taste or Smell *YesNo2. Have you had close contact (less than 6 feet for at least 15 minutes) with someone with confirmed diagnosis of COVID-19 within the last 14 days? *YesNo3. Have You Travelled Internationally In The Last 14 Days? *YesNoReullts of Screening QuestionIf 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 outdoors, or partially outdoor, workplaces). The individual should go home to self-isolate immediate and contact their health care provider or Telehealth Ontario (1-866-797-0000) to find out if they require a COVID-19 test. Submit
