SIGNATURE INDIAN CUISINE​

COVID-19 SCREENING QUESTIONAIRE

Have you travelled outside of Canada in the past 14 days?*
If your answer is yes please self isolate for 14 days
Have you had close contact with a confirmed or probable case of COVID-19?*
If your answer is yes please self isolate and contact your health provider
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. Fever or chills*
Difficulty breathing or shortness of breath*
Cough*
Sore throat, trouble swallowing*
Runny nose/stuffy nose or nasal congestion*
Decrease or loss of smell or taste*
Nausea, vomiting, diarrhea, abdominal pain*
Not feeling well, extreme tiredness, sore muscles*
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Thank you! Your questionaire have sucessfully submited. Results of Screening Questions: • If the individual answers NO to all questions from 1 through 3, they have passed and can enter the workplace. • If the individual answers YES to any questions from 1 through 3, 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