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*YesNoDifficulty breathing or shortness of breath*YesNoCough*YesNoSore throat, trouble swallowing*YesNoRunny nose/stuffy nose or nasal congestion*YesNoDecrease or loss of smell or taste*YesNoNausea, vomiting, diarrhea, abdominal pain*YesNoNot feeling well, extreme tiredness, sore muscles*YesNo2.Have you travelled outside of Canada in the past 14 days?*YesNo3.Have you had close contact with a confirmed or probable case of COVID-19?*YesNoNameThis field is for validation purposes and should be left unchanged.