COVID-19 Screening for Employees

Name of Employee (required)

Have you traveled outside of Canada in the last 14 days? (required)
YesNo

Has someone you are in close contact with tested positive for Covid-19 In the last 14 days? (required)
YesNo

Are you in close contact with a person who is sick with new respiratory symptoms or who recently traveled outside of Canada? (required)
YesNo

Do you have a fever? (temperature = 37.8 °C) T° (required)
YesNo

Do you have chills? (required)
YesNo

Do you have a new or worsening cough (dry or productive)? (required)
YesNo

Do you have shortness of breath or difficulty breathing? (required)
YesNo

Do you have a sore throat or difficulty swallowing ? (required)
YesNo

Do you have a loss of taste or smell? (required)
YesNo

Do you have a headache that is unusual or long-lasting? (required)
YesNo

Do you have a runny or stuffy nose? (not related to seasonal allergies or other known causes or conditions) (required)
YesNo

Do you have nausea, vomiting, diarrhea or abdominal pain? (required)
YesNo

Do you have muscle aches or unexplained fatigue? (required)
YesNo

Do you have any other symptoms not listed above? (required)
YesNo

If you answered Yes to other symptoms, then please list those symptoms.

If you answer YES to any questions, then please go home or stay home, and self-isolate. Go to the BC Covid-19 self-assessment tool @ bc.thrive.health/covid19/en to learn more about the next step to take.

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