Health Questionnaire

COVID Ops Questionnaire

  • Date Format: MM slash DD slash YYYY
  • Fever, Cough, Loss of smell or taste, Difficulty Breathing, Sore throat, Loss of appetite, Extreme fatigue or tiredness, Headache, Body Aches, Nausea or vomiting, Diarrhea
  • I hereby declare that the information provided is true and correct.

If you have checked YES to any questions, stay home, do not report to work, and contact your manager.

If you are displaying symptoms consistent with COVID-19, refer to HealthLink BC at 811.

We share a responsibility for keeping each other safe. Thank you for completing this questionnaire.

If you have any questions, please contact your manager.

*source: WorkSafe BC