EMPLOYEE COVID-19 SCREENING QUESTIONNAIRE
The safety of our employees is our overriding priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance made by Government and its health. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our workforce, we are asking everyone to complete and submit this questionnaire prior to entering the facility. Please respond to each of the following questions truthfully and to the best of your ability.
If you answer YES to any the questions below, please notify someone from Management know before entering.
Are you experiencing any of the following?
(Please check all the boxes that applies to you.)
Shortness of Breath
Have you or anyone in your household had contact with any person with, or under investigation for, COVID-19 in the last 14 days?
Have you or anyone in your household traveled outside of Canada in the last 14 days?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service