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If you answer
YES
to any of the following, please call your manager before coming to work.
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
Sent From
Are you experiencing fever or chills, Difficulty breathing or shortness of breath, cough, sore throat, trouble swallowing, runny nose/stuffy nose or nasal congestion, decrease or loss of smell or taste, nausea, vomiting, diarrhea, abdominal pain, not feeling well, extreme tiredness, sore muscles, fever in excess of 100.4 °F
*
no
yes
Have you traveled outside of Canada in the past 14 days?
*
no
yes
Full Name
*
Date
*
I acknowledge the above to be true
*
yes
American Customers
Canada