COVID Daily Fit for Work Screening
This form must be filled out and submitted before you enter the office - Every Day.

If you have answered NO to all questions, then you have passed and can enter the workplace.

If you have answered YES to any of these questions, then you should not enter the workplace and contact your manager for further instructions which may include seeking medical direction and/or further assessment.
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Your name please *
What branch are you working from today? *
Do you have any of the following symptoms? Check YES or NO *
YES
NO
Fever or Chills
Cough or Barking Cough
Difficulty Breathing or shortness of breath
Decrease or loss of smell or taste
Muscle Aches / Joint Pain
Extreme fatigue, sore muscles
In the last 14 days have you travelled outside Canada and been told to Quarantine? *
Has a doctor, health care provider or public health unit told you that you should currently be isolating? *
In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? *
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
• In the last 10 days have you been identified as a close contact of someone who currently has COVID-19? *
In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? *
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