TSSC Health Screening Questionnaire
Individuals must complete this questionnaire prior to arriving at a training session.

The answer to all questions must be “No” in order to be permitted to a training session.

IMPORTANT: THIS MUST BE COMPLETED ON THE SAME DAY AS YOUR ARRIVAL.
First & Last Name *
Cell Phone Number *
Email address *
Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher) *
Do you have any of the following symptoms? *
Yes
No
Cough
Shortness of breath
Runny nose, sneezing or nasal congestion
Sore throat
Difficulty swallowing
Lost sense of taste or smell
Have you travelled outside of Canada or had close contact with anyone that has travelled outside of Canada in the past 14 days? *
Have you had close contact in the past 14 days with anyone with a new cough, fever or difficulty breathing or a confirmed case of COVID-19? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy