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*

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/chills 2. Cough or barking cough(croup) 3. Shortness of breath 4. Decrease or loss of smell or taste 5. Fatigue and/or malaise 6. Muscle aches/joint pain – Unusual, long lasting not related to getting a COVID vaccine in the last 48 hours, sudden injury, fibromyalgia, or other know causes or conditions you already have. Note: If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue, muscle aches and/or joint pain that only began after vaccination, select “No”

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 10 days, have you tested positive on a rapid antigen / home based test kit, and have not since received a negative lab-based PCR test?

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

COVID Alert exposure notification*

In the last 14 days have you received a COVID Alert exposure notification on your phone? (Answer NO if you are fully vaccinated and / or already went for a test and received a negative result)

Yes
No

Close contact*

In the last 14 days, have you had close contact with a confirmed or probable case of COVID-19? (Answer NO if you are fully vaccinated AND have not been advised to self-isolate by public health.)

Yes
No

Status of someone you live with*

Is anyone you live with currently experiencing any new COVID-19 symptoms and / or waiting for test results after experiencing symptoms other than mild headache, fatigue, muscle aches / joint pain 48 hours after a COVID vaccination? (Answer NO if you are fully vaccinated.)

Yes
No