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*

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/chills (Unless within 48 hours after a vaccination), 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, Headache (Unless mild and within 48 hours of being vaccinated), Fatigue (Unless unusual and within 48 hours of being vaccinated), Muscle aches (Unless unusual and within 48 hours of being vaccinated)*

Yes
No

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

Yes
No

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

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

Yes
No

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

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

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