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COVID-19 self-assessment
admin
2020-11-19T14:18:02-05:00
COVID-19 self-assessment
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PLEASE SELECT SCANNER OR EMPLOYEE #
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Employee #
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HAVE YOU TRAVEL ABROAD (INCLUDING THE UNITED STATES) IN THE LAST 14 DAYS?
Yes
No
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BY PREVENTIVE MEASURE
If you are in the company premises,
please go to the first aid room and communicate with the supervisor using phone # 337
and wait for additional information before going to work
or
If you are at home, contact (514) 251-9550 ext. 313 and wait for additional information before presenting yourself to the company premisses.
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Done
HAVE YOU HAD 'CLOSE CONTACT' WITHIN THE LAST 14 DAYS OR ARE YOU LIVING WITH A CONFIRMED CASE?
Yes
No
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Next
BY PREVENTIVE MEASURE
If you are in the company premises,
please go to the first aid room and communicate with the supervisor using phone # 337
and wait for additional information before going to work
or
If you are at home, contact (514) 251-9550 ext. 313 and wait for additional information before presenting yourself to the company premisses.
Back
Done
DO YOU HAVE ANY OF THE FOLLOWING SYMPTOMS, if nothing please do next :
Fever (38º C or 101,3 ºF and above)
HAD fever within the LAST 24 HOURS
New or worsening cough
Breathing difficulties
Sudden loss of smell or taste?
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Next
BY PREVENTIVE MEASURE
If you are in the company premises,
please go to the first aid room and communicate with the supervisor using phone # 337
and wait for additional information before going to work
or
If you are at home, contact (514) 251-9550 ext. 313 and wait for additional information before presenting yourself to the company premisses.
Back
Done
DO YOU HAVE ANY OR MORE OF THE FOLLOWING SYMPTOMS, if nothing please do next :
Loss of appetite
Unusual headache
Have you had nausea, vomiting or diarrhea in the past 12 hours?
Have you had a sore throat with no other obvious cause?
Unusual muscle pain or stiffness for no obvious reason
Unusual intense fatigue for no obvious reason
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Next
BY PREVENTIVE MEASURE
If you are in the company premises,
please go to the first aid room and communicate with the supervisor using phone # 337
and wait for additional information before going to work
or
If you are at home, contact (514) 251-9550 ext. 313 and wait for additional information before presenting yourself to the company premisses.
Back
Done
THANK YOU FOR YOUR COLLABORATION
Have a nice day 😀
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