Friday, 11 September 2020

Self Assessment

 Here is the self-screening form from the WECHU that staff are expected to complete daily prior to arrival at work.


Here is the link:

An electronic copy in PDF format has been attached as well.

WINDSOR-ESSEX COUNTY HEALTH UNIT

40

Daily Screening Questionnaire for Staff Before Reporting to Work
1. Do you have any of the following new or worsening
symptoms?

Circle One
 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.)

YES NO
 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-
19?

YES NO

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).

YES NO

 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.