COVID-19 Facility Survey

Screening Tool for the Workplace

covid-19

Results of Screening Questions:
• If the individual answers NO to all questions from 1 through 6, they have passed and can enter the workplace.
• If the individual answers YES to any questions from 1 through 6, they have not passed and should be advised that they should not enter the workplace (including any outdoor, or partially outdoor, workplaces). They should go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1 866-797-0000)to find out if they need a COVID-19 test.
• If the worker answered YES to question 6, they must be advised to stay home, along with the rest of the household, until the sick individual gets a negative COVID-19 test result, is cleared by their local public health unit, or is diagnosed with another illness.
• If any of the answers to these screening questions change during the day, the worker should inform their employer of the change and go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if they need a COVID-19 test.
• Any record created as part of worker screening may only be disclosed as required by law.

Resources:
COVID-19 (coronavirus) in Ontario webpage (find a testing location, check your results, how to stop the spread of the virus).
• Ministry of Labour, Training and Skills Development’s Resources to prevent COVID-19 inthe workplace
• Ministry of Health’s COVID-19 Guidance for Essential Workplaces

Download a PDF Copy of the Survey Form.

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