Health Screening Questionnaire - London
This form is required to be completed prior to arriving onsite at an ABT facility
Clock Number *
Do you have a new cough or shortness of breath that cannot be attributed to another health condition? *
Do you have a new sore throat that cannot be attributed to another health condition? *
Do you have a headache or new muscle/body aches that cannot be attributed to another health condition or specific activity such as physical exercise? *
A new onset of congestion or a runny nose that cannot be attributed to another health condition, such as seasonal allergies? *
A new onset of nausea, vomiting or diarrhea that cannot be attributed to another health condition? *
Participated in a group setting with any individuals NOT from your household *
Traveled outside of your home province for anything other than coming to work or receiving medical care or social services *
Been in contact with someone who is showing COVID/Flu like symptoms, is being tested for COVID or is COVID positive *
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