Growing Chefs! Ontario Staff Daily COVID-19 Screening

Growing Chefs! Ontario Daily COVID-19 Screening

Must be completed daily before entering the facility. Inform your GCO contact person or if they are unavailable, Andrew (226-700-2061) immediately if you fail this screening (by saying yes to any of the questions below), stay home, and consult your health-care practitioner on next steps. Note: close contact means within 6 feet of someone or sharing the same household
Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Have you tested positive for COVID-19? *

Yes No
Have you had close contact with a confirmed case of COVID-19 without wearing appropriate personal protective equipment? *

Yes No
Have you travelled outside of Canada in the past 14 days? *

Yes No
Have you been in close contact with someone that has travelled outside of Canada in the past 14 days? *

Yes No
Are you experiencing any of the following symptoms (aside from those explained by other conditions such as seasonal allergies, asthma, pregnancy etc)? *

New onset of cough or worsening of chronic cough Fever (37.8° or higher) Chest congestion Difficulty breathing Sore throat Chills/shaking Fatigue or muscle/joint aches Loss of taste Loss of smell Difficulty swallowing Headaches Nausea/vomiting, diarrhea, abdominal pain Runny nose or nasal congestion Pink eye (conjunctivitis) None of the above
Have you experienced any of the following symptoms in the past 14 days (aside from those explained by other conditions such as seasonal allergies, asthma, pregnancy etc)? *

New onset of cough or worsening of chronic cough Fever (37.8° or higher) Chest congestion Difficulty breathing Sore throat Chills/shaking Fatigue or muscle/joint aches Loss of taste Loss of smell Difficulty swallowing Headaches Nausea/vomiting, diarrhea, abdominal pain Runny nose or nasal congestion Pink eye (conjunctivitis) None of the above
Has anyone in your household experienced any of the following symptoms In the past 14 days (aside from those explained by other conditions such as seasonal allergies, asthma, pregnancy etc)? *

New onset of cough or worsening of chronic cough Fever (37.8° or higher) Chest congestion Difficulty breathing Sore throat Chills/shaking Fatigue or muscle/joint aches Loss of taste Loss of smell Difficulty swallowing Headaches Nausea/vomiting, diarrhea, abdominal pain Runny nose or nasal congestion Pink eye (conjunctivitis) None of the above
Should be Empty:

Growing Chefs! Ontario Daily COVID-19 Screening