COVID-19 Screening Questionnaire This questionnaire is required each day you enter the Nulogx workplace. Name* First Last Email* Phone*1.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 or chills* Yes No Difficulty breathing or shortness of breath* Yes No Cough* Yes No Sore throat, trouble swallowing* Yes No Runny nose/stuffy nose or nasal congestion* Yes No Decrease or loss of smell or taste* Yes No Nausea, vomiting, diarrhea, abdominal pain* Yes No Not feeling well, extreme tiredness, sore muscles* Yes No 2.Have you travelled outside of Canada in the past 14 days?* Yes No 3.Have you had close contact with a confirmed or probable case of COVID-19?* Yes No EmailThis field is for validation purposes and should be left unchanged.
