Ontario Health Questionnaire - Pioneer Family Pools

Good morning, are you scheduled to work today?

Yes

No

Do you have any of the following new or worsening symptoms or signs?

Do you have fever or chills?

Yes

No

Do you have difficulty breathing or shortness of breath?

Yes

No

Do you have a cough?

Yes

No

Do you have a sore throat or trouble swallowing?

Yes

No

Do you have a runny/stuffy nose or nasal congestion?

Yes

No

Do you have a decrease or loss of smell or taste?

Yes

No

Do you have nausea, vomiting, diarrhea, abdominal pain?

Yes

No

Are you feeling not well, tired, or have sore muscles?

Yes

No

Travelled outside of Canada in the past 14 days?

Yes

No

Close contact with confirmed/probable case of COVID-19?

Yes

No

Thanks for answering!

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Phone Number :

Est Hours To Work:

Ontario Health - Employee Questionnaire