By ⦠Newly experienced any of the following symptoms that cannot otherwise be 1..attributed to another condition? Employees can self-screen in advance of work and on site. Yes No Yes No Fever or chills Runny/stuffy nose What the date of your test? Transmission of COVID-19 COVID-19 is easily spread in respiratory droplets by coughing or sneezing. visitors for onsite meetings should provide this questionnaire to each individual visitor sufficiently in advance so as to minimize inconveniences (travel, expenses, etc.). _____ 2. Do you have chills or repeated shaking with chills? By signing below, I acknowledge that I have filled out this form voluntarily and have a full understanding of the information contained therein. COVID-19 Screening Tool for Workplaces (Businesses and Organizations) Version 1 â September 25, 2020 . What were the results? Screening Questionnaire and conduct symptom monitoring every day before entering CCAC buildings and facilities. 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. Have you had close contact with a confirmed or probable case of COVID-19 without wearing appropriate PPE? 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 COVIDâ19. o The questionnaire may be administered in various formats (e.g., in-person, over the 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 They can also be used for other activities. COVID-19 HEALTH SCREENING TOOL. 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. 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. ADHA COVID-19 PATIENT SCREENING QUESTIONNAIRE *Indicate Yes or No and provide relevant comments. Ontario Regulation 364/20. COVID ⦠The following questions are used to screen for COVID-19 before entry into a workplace (business or organization) as per Ontario Regulation 364/20. COVID-19 Screening Questionnaire 1. Patient Name: Date: Do you have a fever, or have you felt feverish recently? This health screening applies to all trades, suppliers, union reps, employees, etc. 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. _____ 2. COVID-19 SCREENING QUESTIONNAIRE Date Time Name Birth Year Gender male femaleother B. Version 6 . It is not to be used Are you having shortness of breath or any difficulty breathing? Visitor Health Screening Questionnaire (COVID-19) At U. S. Steel, safety is our primary core value. 2.) is being investigated or confirmed to be positive for COVID-19? 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? Do you have a cough? This tool provides basic information only and contains recommendations for businesses or organizations for COVID-19 screening as per . REV: March 21, 2020 1 . o Conduct the screening in a format that makes sense for your establishment. 1. Have you or has anyone in your house been tested for COVID-19 coronavirus in the past 14 days? _____ As the outbreak of the coronavirus disease 2019 (COVID-19) No Yes If YES, 1. 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