COVID-19 Daily Screening

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COVID-19 Daily Screening - Vaughan Staff

Thank you for taking the time to answer these questions. The following questions are mandatory for you to complete prior to the start of your shift daily. (Updated January 11, 2022)

Your full name: *

What was your temperature this morning? *

QUESTION 1: Are you experiencing ANY major symptoms of COVID-19? Select all that apply. *

If you selected "YES" to any of the symptoms below, you should stay home and not attend Kid Mechanix. You must isolate for 5 days from when symptoms started and stay in isolation until they are symptom free for 24 hours.

Fever/Chills

Cough

Shortness of Breath

Decrease/Loss of Taste and/or Smell

None of the Above

Required

QUESTION 2: Are you experiencing ANY minor symptoms of COVID-19? Select all that apply. *

If you selected "YES" to any symptoms below, you should stay home and not attend Kid Mechanix. If you are experiencing only one of these symptoms in the last 5 days you must stay home until symptom free for at least 24 hours (48 hours for nausea, vomiting and/or diarrhea). If you have experienced two or more of these symptoms in the last 5 days you must isolate for 5 days from when symptoms started and stay in isolation until you are symptom free for 24 hours (48 hours for nausea, vomiting and/or diarrhea).

Sore Throat

Headache

Extreme Fatigue

Runny Nose and/or Nasal Congestion

Muscle/Joint Pain

Gastrointestinal Symptoms (vomiting, diarrhea)

None of the Above

Required

QUESTION 3: Check off the following that apply: *

I live with someone who is currently isolating because of a positive COVID-19 test.

I live with someone who is currently isolating because of COVID-19 symptoms.

I live with someone who is currently isolating while waiting for COVID-19 test results.

None of these apply to me

Required

QUESTION 4: In the last 5 days, have you tested positive for COVID-19 on a rapid antigen test or home-based self-testing kit? *

Yes - stay home and isolate for at least 5 days from symptom onset

QUESTION 5: Have you been identified as a “close contact” of someone who currently has COVID-19 and been advised to self-isolate? *

If you are fully vaccinated, have no symptoms, and DO NOT live with the COVID-19 positive person, you do not need to self-isolate (but continue to monitor for symptoms). If you are fully vaccinated, have no symptoms, and LIVE with the COVID-19 positive person, self-isolate for 5 days.

Yes

QUESTION 6: Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *

Yes

QUESTION 7: Check off the following that apply: *

In the last 14 days, you travelled outside of Canada and were told to quarantine

In the last 14 days, someone you live with has returned from travelling outside of Canada and is isolating while awaiting results of a COVID-19 test.

None of the above apply to me

Required

If you answered "YES" to any of the questions above, you should stay home and not attend Kid Mechanix. Please refer to the Covid-19 Preparedness and Response Plan for next steps.

Any additional notes about YOU or ANY member of your household's well being?

I authorize that the information provided in this form is truthful and accurate to the best of my knowledge. *

Yes

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