SYS Covid-19 Self Assessment Tool Covid-19 Questionnaire SYS Sign-in policy To prevent the spread of COVID-19 and reduce the potential risk of exposure in our workplace, all SYS team mustcomplete this questionnaire prior arrival each day at the office. Name First Last PhoneAre you experiencing cold, flu or COVID-19-like symptoms, even mild ones?* Yes No Symptoms include: Fever, chills, cough or worsening of chronic cough, shortness of breath, sore throat, runny nose (other than allergies or what is considered "normal" for you), loss of sense of smell or taste, headache, fatigue, diarrhea, loss of appetite, nausea and vomiting, muscle aches. While less common, symptoms can also include: stuffy nose, conjunctivitis (pink eye), dizziness, confusion, abdominal pain, skin rashes or discoloration of fingers or toes.Fever (> 38°C or > 100.4°F)* Yes No Shortness of breath or trouble breathing* Yes No Sore throat* Yes No Severe fatigue* Yes No Runny nose (other than allergies or what is considered "normal" for you)* Yes No Vomiting* Yes No Self isolation check:Have you been asked to self-isolate by a healthcare professional or has anyone in your household or anyone you've spent time with tested positive or awaiting a test result for COVID-19?* Yes No Travel check:Have you or anyone in your household travelled anywhere outside of Canada in the last 14 days?* Yes No Disclaimer: If you answered YES to any of the above, you are not permitted to work or visit the office.Disclaimer 1* I have answered "NO" to all the above questions and agree to wash my hands as soon as entering the premises and throughout the day.Disclaimer 2* I agree to respect the mandated spatial separation (6 feet) and wear a mask in the common areas and when I leave my desk.Disclaimer 3* I agree to disinfect my workstation, plexi glass, supplies, and door handles at the end of each day.Date* MM slash DD slash YYYY
