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Daily COVID-19 required workplace screening questionnaire

We are committed to protecting your privacy and are not collecting personal identifying information.
1. Do you have any of the following symptoms or signs?
  • Fever or chills
  • Cough
  • Loss of sense of smell or taste
  • Difficulty breathing
  • Sore throat
  • Loss of appetite
  • Extreme fatigue or tiredness
  • Headache
  • Body aches
  • Nausea or vomiting
  • Diarrhea
*This question is required.
2. Have you had close contact with a confirmed case of COVID-19 in the last 14 days and not spoken with Public Health? *This question is required.
3. Are you currently directed or instructed by a Public Health official (nurse, doctor, or 811 call taker) to self-isolate? *This question is required.
4. Have you travelled outside of Canada in the past 14 days? *This question is required.
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