Pre-Entry Employee Covid-19 Self-Screening

Printable Version
"Ontario Stay At Home" Notice: AV Gauge & Fixture Inc. & AV Gauge Automation have been deemed by both the Federal and Ontario Governments to be an Essential Workplace under sections 1 and 19 of the Essential Workplaces Order.
As an employee, you are deemed to be an Essential Worker and are permitted to travel to and from work.
 
Required Screening Questions:
     1. Do you have any of the following NEW or WORSENING acute respiratory symptoms? (Fever, Cough, Difficulty Breathing)
     2. Have you had close contact with a confirmed or probable case of COVID-19 in the last 14 days?
     3. Have you travelled outside of the country in the past 14 days? (Excluding business trips in the capacity of an essential worker)
 
If you answer NO to all questions from 1 through 3, print your employee # and submit. You are permitted to enter the workplace.
 
 
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*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 answer YES to any questions from 1 through 3, you are not permitted to enter the workplace. You should stay/return home to self-isolate immediately. Report to your employer and contact your health care provider to find out if you need a Covid-19 test. If being tested, you must not return to work until negative result is confirmed.