59 Line 4 North Oro-Medonte, ON L0L 2L0 | Phone: 1-800-268-3781
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SWRC Staff Covid-19 Screening Questionnaire

  • Before you come to the office for work or any reason, please answer all of the Covid-19 screening questions below. Thank you.
  • By entering your name, you verify that the answers in this questionnaire are true and that you, personally, have answered them. Thank you.
  • Only if applicable to the preferred phone number.
  • MM slash DD slash YYYY
  • Which regional office will you be entering?
  • Approximately what time will you be entering the building.
  • Approximately what time will you be leaving the building.
  • Do you have any of these new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions. Please select all that apply.
  • Have you travelled outside of Canada in the past 14 days?
  • Have you had close contact with a confirmed or probable case of COVID-19?
  • Results of Screening Questions:

    • If you answerd NO to all questions, then you have passed and can enter the workplace.

    • If you answered YES to any questions, you have not passed and are advised to not enter the workplace (including any outdoor, or partially outdoor, workplaces). Please self-isolate immediately and contact your health care provider or Telehealth Ontario (1 866-797-0000)to find out if you need a COVID-19 test.

    Please remember to fill out this questionnaire every day before coming onsite. Thank you!

  • This field is for validation purposes and should be left unchanged.