*If you fill out a hard copy of the form, please turn this form in to your supervisor as proof of daily active screening.

ATTENTION:

If you did not complete Covid-19 Self-Assessment or based on its results you are required to self-isolate, you are not permitted to enter the workplace. You should return home to self isolate immediately. Report to your employer and contact Telehealth Ontario (1-866-797-0000) to find out if you are eligible for a Covid-19 test. If being tested, please consult Windsor-Essex County Health Unit if you can return to work until your test result is confirmed.