Screening Form (Covid-19)

Daily Fit for Work Screening Questionnaire

We require you to fill out the below questionnaire to assist in determining your fitness to work or visitation during the COVID-19 pandemic to provide a safe environment for staff, volunteers, contractors, and families.

The information in this questionnaire is collected and will be used and disclosed solely for the purposes of determining fitness for work or visitation during the COVID-19 pandemic.

Ensure at all times you are following protocols for hand hygiene and also remember to clean your keys, phone, computers and other personal items, as well as work areas.

The questionnaire intends to identify new symptoms or worsening of symptoms that are not related to allergies, chronic or pre-existing conditions.

Those with symptoms normally related to pre-existing conditions or allergies can still go to work or visit.