Employee Screening
 The completion of this form on a daily basis is required in our shared effort to keep you and your colleagues safe. If you mislead, you put yourself and others at needless risk and you will face serious consequences.
Do not complete this screening tool if: you are on vacation, using BOT/MOT, taking a leave of absence, or you have called in sick today. Report your absence using WFM or your usual departmental method.
Do not attend work if: you are sick. Refer to the Return to Work Protocols and FAQs available on the COVID-19 Dashboard site for guidance on when you can return to work.
 Who is reporting
An email, phone # or name
 Symptom Checking
Symptoms should be new, worsening, and not related to other known causes or conditions you already have.
In the last *5 days, have you experienced any of the symptoms below?

If you have already completed your *5 day isolation period, you don't have a fever, and your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea), select “No”.
*10 days if you are unvaccinated or immune compromised.
Fever and/or chills
Fever and/or chills
(Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher)
Cough or barking cough (croup)
Cough or barking cough (croup)
Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
Shortness of breath
Shortness of breath
Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
Sore throat (not related to seasonal allergies, acid reflux, or other known causes or conditions you already have)
Sore throat
Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)
Decrease or loss of smell or taste (not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have)
Decrease or loss of smell or taste
(Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have)
Runny or stuffy/congested nose
Runny or stuffy/congested nose
(Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have)
Headache
Headache
New, unusual, long-lasting (not related to getting a COVID-19 vaccine or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)
Nausea, vomiting and/or diarrhea
Nausea, vomiting and/or diarrhea
(Not related to irritable bowel syndrome, anxiety, medication side effects, menstrual cramps, or other known causes or conditions you already have)
Muscle aches/joint pain
Muscle aches/joint pain
Unusual, long-lasting (not related to getting a COVID-19 vaccine or flu shot in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
Extreme Fatigue
Extreme Fatigue
Unusual tiredness, lack of energy (not related to getting a COVID-19 vaccine or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
 COVID-19 Related Questions
In the last 14 days, have you travelled outside of Canada and been advised to quarantine (as per the federal quarantine requirements)?
In the last 14 days, have you travelled outside of Canada and been advised to quarantine (as per the federal quarantine requirements)?
If you were told at the border/port of entry into Canada that you did not need to quarantine), select "No".
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
This can be because of an outbreak or contact tracing.
Question14
In the last 10 days, have you tested positive for COVID-19?
If you are fully vaccinated, not immune compromised, and the test was more than 5 days ago, select “No”.
This includes a positive COVID-19 test result on a lab-based PCR test, rapid antigen test, or a home-based self-testing kit.
Question20
Do any of the following apply?
  • You live with someone who is currently isolating because of a positive COVID-19 test
  • You live with someone who is currently isolating because of COVID-19 symptoms
  • You live with someone who is isolating while waiting for COVID-19 test results
Select "No" if:
  • You completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test); or
  • Your household member is isolating because of COVID-19 symptoms but has already received a negative PCR or rapid molecular test or two negative rapid antigen tests 24-48 hours apart
Where are you working from today?
Where are you working from today?
I will be working from home all day
I will be on City premises all day or may be attending a City worksite at some point today