COVID-19

Name: SERVICAD Inc.
Address: 980 Fraser Dr. Suite 102, Burlington, ON, L7L 5P5, Canada
Telephone: 905-901-3365
Price range: $

Employee Screening

Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

1 – Fever or chills*
- Yes
- No
2 – Difficulty breathing or shortness of breath*
- Yes
- No
3 – Cough*
- Yes
- No
4 – Sore throat; trouble swallowing*
- Yes
- No
5 – Runny nose/stuffy nose or nasal congestion*
- Yes
- No
6 – Decrease or loss of smell or taste*
- Yes
- No
7 – Nausea, vomiting, diarrhea, abdominal pain*
- Yes
- No
8 – Not feeling well, extreme tiredness, sore muscles*
- Yes
- No
9 – Have you travelled outside of Canada in the past 14 days?*
- Yes
- No
10 -Have you had close contact with a confirmed or possible case of COVID-19?*
- Yes
- No
Today's Date*
MM slash DD slash YYYY
Your Name*
First Last
Email*

If you answer NO to all questions above, you have passed and can enter the workplace.

If you answered YES to any questions from 1 through 3, you have not passed and should not enter the workplace (including any outdoor, or partially outdoor areas). Please inform your manager and go home to self-isolate immediately. Contact your health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test. If you answered YES to any other questions please review with your manager to discuss next steps. Thank you.