Staff-R.S.O.S.C.S Daily Health Screening Questionnaire
Attention Please!!! All RSOSC staff must fill out this questionnaire to decide if they should enter the program either at RSS location or at ELC location daily. It MUST be submitted BEFORE or just after you arrive for your shift. Thank you for understanding and cooperation.
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1. What is your name? *
2. Which RSOSC location you are working at? *
3. Please document the date of filling out the questionnaire. *
4. Please document the time of filling out this questionnaire. *
5. Do you have any new onset of following core symptoms ? If yes, please check the symptoms below, if no, please check the last box *
6. Have you travelled outside Canada in the last 14 days? (Individuals are legally required to quarantine for 14 days when entering or returning to Alberta from outside Canada unless exempted by the Alberta COVID-19 Border Testing Pilot Program.) *
7. Have you had close contact with a case of COVID-19 in the last 14 days? (Face-to face contact within 2 metres for 15 minutes or longer, or direct physical contact such as hugging) If yes, individuals are required to quarantine for 14 days, or if individuals develop symptoms, please call health link 8-11 to determine for if testing is recommended. *
8. Please note: If an individual answers YES to any of the questions above, they must not be allowed to attend the program. *Individuals with fever, cough, shortness of breath, runny nose, or sore throat, are required to isolate for 10 days per CMOH Order 05-2020 OR receive a negative COVID-19 test and feel better before returning to our program. If you have specific health concerns that we should be aware of, please clarify below. Thank you.
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