Health Screening Questionnaire For Staff

  • COVID-19 Screening Tool for Workplaces (Businesses and Organizations)

    Version 2 – April 1, 2021

    At this critical point in the pandemic, the following public health measures are crucial to help prevent and limit the spread of COVID-19:
    https://www.ontario.ca/page/covid-19-response-framework-keeping-ontario-safe-and-open#levels

    Refer to Ontario.ca/covidresponse to learn what public health measures are in place in our community.

    This tool provides basic information only and contains recommendations for businesses or organizations for COVID-19 screening as per Ontario Regulation 364/20. It is not to be used as a clinical assessment tool or intended to take the place of medical advice, diagnosis or treatment. Where the document includes references to legal requirements, it is not to be construed as legal advice. This document may also not be applicable to health care settings, and some non-health care workplaces (e.g., congregate living settings) where existing screening is already in place.

    Workplaces should implement this screening for any workers or essential visitors entering the work environment. This does not include patrons entering a workplace (e.g., customers entering a grocery store, restaurant, bar or other food or drink establishment). It also excludes emergency services or other first responders entering a workplace for emergency purposes. Further, essential workers who travel outside for Canada for work purposes should not be excluded entry on this basis alone.

    Screening should occur before or when a worker enters the workplace at the beginning of their day or shift, or when an essential visitor arrives.

    At a minimum, the following questions should be used to screen individuals for COVID-19 before they are permitted entry into the workplace (business or organization). This tool may be adapted based on need and the specific setting.

    Instructions in the tool should be followed. Anyone who does not pass screening should be advised that they should not enter the workplace and should self-isolate, call their health care provider or Telehealth Ontario. Once an individual has passed the screening questions, they should be allowed to enter the workplace, but should report any symptoms immediately

    Employers must also meet all obligations under the Occupational Health and Safety Act.

    1 Refers to staff (e.g., workers) and is intended to include students, contractors or volunteers that conduct business or related activities where applicable and appropriate.
    2 Essential visitors include individuals providing a service in the establishment who are not employees or patrons of the establishment (e.g., delivery, maintenance, contract workers).

     
  • Required Screening Questions

  • Do you have ONE or more of the following symptoms?

  • (temperature of 37.8°C/100.0°F or greater)

  • If you answered YES to any of these questions, please self-isolate at home and get tested or speak with your health care provider.

    Screenshot at Feb 04 20-49-25