Staff Daily Health Check

Fever/Chills

Yes

No

Cough

Yes

No

Loss of taste or smell

Yes

No

Difficulty breathing/ shortness of breath

Yes

No

Runny nose (unrelated to allergies)

Yes

No

Sore throat or difficulty swallowing

Yes

No

Not feeling well, headache, unexplained tiredness and muscle aches

Yes

No

Nausea, vomiting, diarrhea, abdominal pain

Yes

No

In the last 14days, have you had close physical contact with a person who was sick with a respiratory illness (had a new or worsening cough, fever or difficulty breathing)?

Yes

No

In the last 14days, have you had close physical contact with a person who has returned from travel outside of Canada in the last 14days?

Yes

No

In the last 14days, have you had close physical contact with a person who was a confirmed or probable case of COVID-19?

Yes

No

In the last 14days, have you travelled outside of Canada?

Yes

No

A Thoughtful Balance Between Substance and Style + Nature and Science + People and Spirit

Please fill out the following health questionnaire to confirm your health at the start of your shift.

If you answered yes to any of these questions: please return home and self-isolate. Visit OttawaPublicHealth.ca/COVIDCentre for more information about getting tested.