Covid 19 Screening Questions | Firefly Circus Academy

Covid-19 Screening Questions

Novel coronavirus (COVID-19) Guidance

Screening Questionnaire

We require you to answer the below questionnaire to assist in determining your fitness during the COVID-19 pandemic to provide a safe environment for staff, and participants. The information in this questionnaire is collected under the authority of FOIP section 33 (c) and will be used and disclosed solely for the purposes of determining fitness for work or visitation during the COVID-19 pandemic.

You must follow hand hygiene protocols and remember to clean your keys, phone, computers and other personal items.

The questionnaire only relates to new symptoms or a worsening of symptoms related to allergies, chronic or preexisting conditions. Those with symptoms related to pre-existing conditions or allergies can still go to work or visit.

Covid-19 Screening Questions

Screening Questionnaire

Risk Assessment: Screening Questions

1. Do you have any of the following symptoms which are new or worsened if associated with allergies, chronic or pre-existing conditions: fever, cough, shortness of breath, difficulty breathing, sore throat, and/or runny nose? *

2. Have you returned to Canada from outside the country (including USA) in the past 14 days? *

In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment:

3. Did you have close contact* with a person who has a probable** or confirmed case of COVID-19? *

4. Did you have close contact* with a person who had an acute respiratory illness that started within 14 days of their close contact* to someone with a probable** or confirmed case of COVID-19? *

5. Did you have close contact* with a person who had an acute respiratory illness who returned from travel outside of Canada in the 14 days before they became sick? *

6. Did you have a laboratory exposure to biological material (i.e. primary clinical specimens, virus culture isolates) known to contain COVID-19? *