Annex Business Media COVID-19 Health Check

COVID-19 Health Check Questionnaire

Annex Business Media requires all employees and visitors entering our workplace to complete a COVID-19 Health Check questionnaire prior to arrival. Thank you for keeping yourself and those around you healthy and safe!

If you answer “YES” to any of the questions below, while we would love to see your smiling face in person, unfortunately we are unable to allow you to enter the workplace or interact face-to-face with our employees. Please stay home and self-isolate immediately and contact your health care provider or Telehealth Ontario (1-866-797-0000) to determine if you need a COVID-19 test. Don’t forget to call your manager to update them on your current status.

If you answer “NO” to all of the questions below, please remember to sanitize your hands upon entering the workplace. If physical distancing will be a challenge, you must wear a mask.

Question Title

* 1. Please enter your contact information

Name

Email Address

Question Title

* 2. Do you have ANY of the following NEW or WORSENING symptoms or signs? Symptoms should not be chronic or related to other known cause of 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

Yes, I am experiencing at least one or more of the above symptoms

None of the above