Covid Screening Tool
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First Name:
Last Name:
Company:
WFS
Other
Department:
Accounting
Ruminant Team
Swine Team
Poultry Team
Production
Transport
IT
Purchasing
Customer Service/QC
HR/Safety
Senior Manager
Maintenance/Boiler
Monkton
Company Name:
Contact Number:
1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
Fever or chills
Yes
No
Difficulty breathing or shortness of breath
Yes
No
Cough
Yes
No
Sore throat, trouble swallowing
Yes
No
Runny nose/stuffy nose or nasal congestion
Yes
No
Decrease or loss of smell or taste
Yes
No
Nausea, vomiting, diarrhea, abdominal pain
Yes
No
Not feeling well, extreme tiredness, sore muscles
Yes
No
2. Have you travelled outside of Canada in the past 14 days? “Please check ‘No’ if you cross the border for an essential service (e.g. trucking) as this is not considered ‘travel’.”
Yes
No
3. Have you had close contact with a confirmed or probable case of COVID-19?
Yes
No
Submit
Submit