Covid Employee Sign-In EMPLOYEE COVID-19 SCREENING QUESTIONNAIRE In our ongoing efforts to ensure the health and safety of everyone on our premises, enhanced screening guidelines have been implemented. You are required to wear facial coverings and maintain social distancing at all times. Please respond to each of the following questions truthfully and to the best of your ability. Your participation is important to help us take precautionary measures to protect you and our other employees. In the past 14 days, I attest I have not experienced any of the following symptoms: * No Fever or Chills No Cough, difficulty breathing or sore throat No Loss of senses, ie. Smell, Taste, Other No Sneezing, Nasal Congestion, Runny Nose No Nausea, Vomiting, Diarrhea, Abdominal Pain No Headache, Muscle Ache or Feeling Unwell No Unexplained Fatigue, General Malaise No Conjunctivitis (pink eye) Have you had contact with a probable or confirmed case of COVID-19 in the past 14 days? * Yes No Have you travelled outside Canada in the past 14 days? * Yes No I hereby certify that the responses provided above are true and accurate to the best of my knowledge. * Please Sign Your FULL Name Here Submit
