COVID-19 Contractor Screening Form

Preserving the health and wellness of our employees is the GRCA's priority. To prevent the spread of COVID-19 and to reduce the potential risk to our workforce, we are conducting a simple screening questionnaire that we are asking you to complete at the beginning of each work day, and submit to your GRCA contact person in advance of starting work. If at any time there are changes in your health and/or situation please notify your GRCA contact person right away.

This checklist is meant to keep you and your colleagues healthy. It is only a basic checklist and not meant to take the place of medical advice, diagnosis or treatment. When completing this checklist, please only take into account new or worsening symptoms. Do not take into account symptoms related to chronic conditions (i.e. seasonal allergies), or those that can be related to other known conditions that you may have.

Your Name *

You must provide a name.

Your Organization *

You must name an organization.

Your Email Address *

You must provide an email.

Your GRCA Contact Person *

Invalid contact. You must select a person as you type.

1. In the last 5 days (if you are vaccinated) or 10 days (if you are unvaccinated) have you experienced any of these symptoms?

Fever and/or chills: Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher

Cough or barking cough (croup)

Shortness of breath

Decrease or loss of smell or taste

Fatigue. lethargy, malaise and/or myalgias

Nausea, vomiting and/or diarrhea

Headache

Runny or Congested Nose

Sore Throat

Severe Chest Pain

Severe Difficulty Breathing

Feeling Confused or Unsure Where You Are/Losing Consciousness

Select "No" if all of these apply:

you have completed your isolation period of 5 days if you are fully vaccinated (10 days if you are unvaccinated) or you tested negative for COVID‐19 on one PCR test or rapid molecular test or two rapid antigen tests taken 24 to 48 hours apart, and
you do not have a fever, and
your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)

If you answered "yes" to any of the above mentioned symptoms, unrelated to having received a COVID-19 vaccination, DO NOT report to work and immediately contact your Supervisor. You may also need to contact Public Health or your health care provider for further guidance on self-isolation.

You must answer this question

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

If exempt from federal quarantine requirements as directed by the border agent at your point of entry (for example, you have two or more doses of a COVID-19 vaccine and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select "No."

You must answer this question

3. Do any of the following apply?

You live with someone who is currently isolating because of a positive COVID-19 test
You live with someone who is currently isolating because of COVID-19 symptoms
You live with someone who is isolating while waiting for COVID-19 test results

Select "No" if you:

are 18 or older and have received your booster dose, or
are 17 or younger and are fully vaccinated, or
completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test)

You must answer this question

4. In the last 5 days (if you are vaccinated)/10 days (if you are unvaccinated), have you tested positive on a rapid antigen test, molecular test, or home-based self-testing kit?

Select "No" if you have already completed your isolation period of 5 days (if you are vaccinated)/10 days (if you are unvaccinated) because your symptoms started before your positive test result, and:

you do not have a fever, and
your symptoms have been improving for 24 hours (48 hours for nausea, vomiting, and/or diarrhea)

You must answer this question

5. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

You must answer this question

If you have answered "YES" to any of the questions, DO NOT report to work and immediately contact your GRCA contact. You may also need to contact Public Health or your health care provider for further guidance on self-isolation.