COVID-19 Screening Tool for Workplaces (Businesses and Organizations) Version 1 – September 25, 2020 . To reduce the risk of spread of COVID-19 in the workplace, employees should be screened prior to entering work. Patient Name: Date: Do you have a fever, or have you felt feverish recently? Yes No . The following questions are used to screen for COVID-19 before entry into a workplace (business or organization) as per Ontario Regulation 364/20. Employees can self-screen in advance of work and on site. o Conduct the screening in a format that makes sense for your establishment. By signing below, I acknowledge that I have filled out this form voluntarily and have a full understanding of the information contained therein. Yes No • fever > 38°C or think you have a fever or chills • cough • sore throat/ hoarse voice • shortness of breath/ breathing difficulties • loss of taste or smell COVID-19 HEALTH SCREENING TOOL. Visitor Health Screening Questionnaire (COVID-19) At U. S. Steel, safety is our primary core value. visitors for onsite meetings should provide this questionnaire to each individual visitor sufficiently in advance so as to minimize inconveniences (travel, expenses, etc.). Guidelines: To prevent the spread of COVID-19 and to reduce the potential risk of exposure to the workforce, please conduct this questionnaire, daily, at designated entry points, prior to accessing the site. This tool provides basic information only and contains recommendations for businesses or organizations for COVID-19 screening as per . COVID-19 Screening Questions Symptom and exposure screening questions (check all that apply) Do you have a new onset, or worsening, of any ONE of the following symptoms? COVID-19 Risk Assessment Tool As you use this risk assessment tool, including the simple questionnaire at the end, the following four words should guide you: People, Space, Time, and Place. Do you have a cough? They can also be used for other activities. o It can be a questionnaire, with specific questions to help identify if an individual is reporting possible symptoms of COVID-19 or recent exposure to COVID-19. _____ COVID-19 Screening Tool reopeningri.com | health.ri.gov/covid REOPENING RI Recommended tool to screen employees, clients, and/or visitors for symptoms of COVID-19. No Yes If YES, 1. As the outbreak of the coronavirus disease 2019 (COVID-19) REV: March 21, 2020 1 . _____ 2. is being investigated or confirmed to be positive for COVID-19? What the date of your test? COVID-19 SCREENING QUESTIONNAIRE Date Time Name Birth Year Gender male femaleother B. It is not to be used Ontario Regulation 364/20. COVID … Version 6 . 2.) COVID-19 Screening Questionnaire 1. Screening Questionnaire and conduct symptom monitoring every day before entering CCAC buildings and facilities. Coming to a CCAC campus or facility sick or with symptoms puts the entire college community at an unnecessary risk for spreading the novel coronavirus, the virus that causes COVID–19. 1. Transmission of COVID-19 COVID-19 is easily spread in respiratory droplets by coughing or sneezing. Are you having shortness of breath or any difficulty breathing? Have you had close contact with a confirmed or probable case of COVID-19 without wearing appropriate PPE? Do you have chills or repeated shaking with chills? o The questionnaire may be administered in various formats (e.g., in-person, over the ADHA COVID-19 PATIENT SCREENING QUESTIONNAIRE *Indicate Yes or No and provide relevant comments. I also agree that all the information provided is accurate to the best of my knowledge. What were the results? Have you or has anyone in your house been tested for COVID-19 coronavirus in the past 14 days? By … _____ 2. 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