Covid-19 Pre-Work Screening Tool | Great Lakes Copper Ltd.

Name*

First Last

Person I report to directly (Group Lead, Supervisor, Manager etc.)*

Working Hours*

In the last 5 days (10 days if NOT Fully Vaccinated), have you experienced any of these symptoms?

New or worsening symptoms*

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 and/or chills 2. Difficulty breathing or shortness of breath 3. Cough 4. Not feeling well, extreme tiredness, sore muscles 5. Decrease or loss of taste or smell 6. Headache 7. Unusual Fatigue - extreme tiredness 8. Muscle aches/joint pain 9. Sore throat or difficulty swallowing 10. Runny or stuffy/congested nose 11. Nausea, vomiting and/or diarrhea Select "No" if you have already completed your isolation period of 5 days, and you don't have a fever, and your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).

Yes
No

Isolating at home*

Has a doctor, health care provider or public health unit advised you should be isolating at home?

Yes
No

Positive Test*

In the past 5 days (10 days if NOT Fully Vaccinated), have you tested positive on a rapid antigen / home based test kit? Select "No" if you have already completed your isolation period of 5 days because your symptoms started before your positive test result, and you don't have a fever, and your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).

Yes
No

Travel*

Have you traveled outside of Canada in the past 14 days AND been advised to quarantine, per the federal quarantine requirements?

Yes
No

Status of someone you live with*

Do any of the following apply? 1. You live with someone who is currently isolating because of a positive COVID-19 test. 2. You live with someone who is currently isolating because of COVID-19 symptoms. 3. You live with someone who is waiting for COVID-19 test results. Select "No" if you: are 18 or older and have received your booster dose, or are 17 or younger and are fully vaccinated, or completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test)

Yes
No