School Screening Please enable JavaScript in your browser to complete this form. – Step 1 of 2Today's Date *Your Name *FirstLastWho is your manager? *Aaron JohnsonAndy KrampitzArley MacKinnonBridget AccaputoBrooks ColeCeline MartinChristeen WalkerDagmara NowakowskiEileen McCuskerKorczakEric ChoiGilles MartinHolly WisemanJason DelageJim McCannJoe IozzoJordan KirkMarika KisbeyMartin DarrochMelissa SegriffMichelle MosesNorm GouletParker McGrathRae RamsayRobyn SteedRod LundahlSandra CrossleySandra GouletSarah MacLeodShad SeresinheTed AdamsTom LeonardTrisha FarrellOtherManagers name:Name and City of School You Are AttendingNextHave you travelled outside of Canada in the past 14 days? *YesNoHave you had close contact with a confirmed or probable case of COVID-19? *YesNoClose contact definition: (1) You were within 2 metres of a person who is infectious. There are different activities that increase risk in this case. For example, face to face conversations increase the risk and the longer you spend with an infected person, the greater the risk. (2) You had multiple close encounters with a person diagnosed with COVID-19 over a 24-hour period without masking, distancing and/or use of PPE. (3) You had close, physical contact with a person diagnosed with COVID-19, such as a hug, hand shake or massage. (4) You live in the same home as someone diagnosed with COVID-19. (5) You worked physically near (less than 2 metres of physical distance) a person who is infectious for a prolonged period of time. (6) You took lunch breaks or socialized in the break room with a person diagnosed with COVID-19 and were within 2 metres. Have you taken a rapid antigen test or home-based self-testing kit?YesNo returning hr@edgeimaging.ca. Managers Was it positive or negative?PositiveNegativePlease complete a rapid test or home-based self-testing kit before returning to work. If you do not have a rapid test or home-based self-testing kit, use the following link to locate a rapid distributor (https://covid-19.ontario.ca/rapid-test-locator) or reach out to the Human Resources Department at hr@edgeimaging.ca.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.The most common symptoms of COVID-19 that require immediate self-isolation and, if eligible, COVID-19 testing include:Fever (temperature of 37.8°C/100.0°F or greater) and/or chillsCough (that is new or worsening (e.g. continuous, more than usual if chronic cough) including croup (barking cough, making a whistling noise when breathing)Shortness of breath (dyspnea, out of breath, unable to breathe deeply, wheeze, that is worse than usual if chronically short of breath)Decrease or loss of smell or tasteTwo or more of the following symptoms of COVID-19 require immediate self-isolation and, if eligible, COVID-19 testing include:Extreme fatigue, lethargy, or malaise (general feeling of being unwell, lack of energy, extreme tiredness) that is unusual or unexplainedMuscle aches or joint pain that are unexplained, unusual, or long-lastingNausea, vomiting, and/or diarrheaSore throat (painful swallowing or difficulty swallowing)Rhinorrhea or nasal congestion (runny nose or stuffy nose)Headache that is new and persistent, unusual, unexplained, or long-lastingCheckboxesNone of the AboveOther symptoms that may be associated with COVID-19 and should be monitored, include:Abdominal pain that is persistent or ongoingConjunctivitis (pink eye)Decreased or lack of appetiteSubmit
