Employee COVID Self Assessment
Please fill this form out daily. If you indicate you are experiencing symptoms or answer yes to any questions below, you will not be permitted to enter the premises.
 
In this case please contact your supervisor to discuss next steps.

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.

Fever or chills
Difficulty breathing or shortness of breath
Cough or barking cough
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Fatigue, extreme tiredness, lethargy
In the past 14 days, have you travelled outsideof Canada AND been advised to quarantine (as per Federal quarantine regulations)
Has a doctor, health care provider or public health unit told you you shoud currently be isolating(staying at home)?
In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? (If you have since tested negative on a lab-based PCR test, select "NO")
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for a test result after experiencing symptoms? (If you are fully immuized or have tested postive for COVID-19 in the last 90 days and since been cleared, select "NO")

If you answered "yes" to one or more of these questions you may not enter the premises. Self Isolate and contact your health care professional immediately.

Thank you. Have a great day!