COVID-19 Screening Fuller Life Church
All staff must complete before beginning their work shift or entering the workplace.
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 Do you have any of the following new or worsening symptoms?
If you are fully vaccinated** or have tested positive for COVID-19 in the last 90 days and since been cleared, select “None of the symptoms above” • If the household member’s mild tiredness, sore muscles or joints occurred within 48 hours after getting a COVID-19 vaccine, select “None of the symptoms above”. If their symptoms last longer than 48 hours, select the appropriate symptoms.
First Name, Last Name *
Email Address *
Phone Number *
Date *
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1. Do you have any of the following new or worsening symptoms? *
Required
2. Does anyone in your household have one or more of the above symptoms and/or are waiting for test results after experiencing symptoms? *
Required
3. In the last 10 days have you been notified as a close contact of someone with COVID-19 or been told to stay home and self-isolate? *
Required
4. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? *
Required
5. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements? *
Required
If “YES” to questions 2, 3, 4 or 5: Do not enter this location and follow Toronto Public Health advice
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