Here is the self-screening form from the WECHU that staff are expected to complete daily prior to arrival at work.
Friday, 11 September 2020
Here is the link:
UserFiles/Servers/Server_ 58369/File/About/COVID/ Screening%20Questionnaire% 20for%20Staff.pdf
An electronic copy in PDF format has been attached as well.
WINDSOR-ESSEX COUNTY HEALTH UNIT
Daily Screening Questionnaire for Staff Before Reporting to Work
1. Do you have any of the following new or worsening
Fever (37.8 C or greater) YES NO
New or worsening cough YES NO
Shortness of Breath / Difficulty Breathing YES NO
Sore throat YES NO
Chills YES NO
Difficulty swallowing YES NO
Runny Nose / Nasal Congestion (in absence of underlying
reason for this such as seasonal allergies, post nasal drip, etc.)
Feeling unwell / Fatigued/malaise YES NO
Nausea / vomiting, diarrhea , abdominal pain YES NO
Unexplained loss of appetite YES NO
Loss of sense of taste or smell YES NO
Muscle/ Joint aches YES NO
Headache YES NO
Conjunctivitis (Pink Eye) YES NO
2. Have you or anyone in your household had close contact
(face-to-face contact within 2 metres) with anyone with a
respiratory illness or confirmed or probable case of COVID-
3. Have you or anyone in your household, returned from travel
outside of Canada in the last 14 days? ? (This does not
include cross-border commuters travelling daily (not
including overnight stays) who live in the child’s household).
If you have answered “NO” to all questions, you may report to work.
If you have answered “YES” to any of part of Question 1, please DO NOT report to work at this time.
Please remain home and use the COVID-19 Self-Assessment Tool to determine whether a COVID-19
test or medical attention is required.
If you have answered “NO” to Question 1, but “YES” to question 2, please DO NOT report to work at
this time. Complete the COVID-19 Self-Assessment Tool to determine whether a COVID-19 test is
needed or medical care is required. Based on the exposure, the staff member may be permitted to
report to work only as directed by a primary care provider.
If you have answered “NO” to Question 1 and Question 2, but “YES” to Question 3, the staff member
may report to work on the advice of a primary care provider provided they are continually monitored
for symptoms related to COVID-19.