KCDSB Staff Screening Survey

1. Are you experiencing ONE or more of the following symptoms, not related to an underlying medical condition?

Fever of 37.8 degrees Celsius or above
New or worsening cough
Shortness of breath
Difficulty breathing
Sore throat
Difficulty swallowing
Decrease or loss of sense of taste or smell
Chills
Headaches
Unexplained fatigue/malaise/muscle aches
Nausea/vomiting, diarrhea, abdominal pain
Pink eye (conjuctivitis)
Runny nose or nasal congestion without other known cause.

Yes

No

2. Have you traveled outside of Canada in the last 14 days?

Yes

No

3. In the last 14 days, have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?

Yes

No

4. In the last 14 days, are you or someone in your residence awaiting results of a COVID-19 test results, excluding those awaiting asymptomatic surveillance testing?

Yes

No

I confirm that the information given in this form is true, complete and accurate.

Yes

No

Thank you for taking this brief screening.

You may return to your current duties.

Thank you for taking this brief screening.

Based on your responses please consider your health care options to protect both yourself and your co-workers.

Survey Screening