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COVID-19 Self Screening Questionnaire

Please complete the Self-Screening Tool daily before arriving on campus.

 

The results displayed at the end of this questionnaire will need to be viewed by screening personnel. This questionnaire is only meant to be a tool and cannot diagnose you. If you have medical questions or concerns about your personal risk factors, consult a health care provider or the Public Health Sudbury and District.

 

 

NOTE: This questionnaire will be used for self screening and contact tracing purposes only.

 

All personal information collected in respect to the COVID-19 Self Screening Questionnaire pursuant to The Laurentian University of Sudbury Act, 1960. Such information will only be used for the purposes described above and will be confidentiality shared with Health and Safety and Human Resources and Organizational Development.   Questions concerning the collection, use, and disclosure of this information are to be addressed to: Human Resources and Organizational Development, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6 or at hrd@laurentian.ca. 

 

 

There are 6 questions in this survey.
(This question is mandatory)
Please Indicate your Last Name.
Please indicate your First Name
Please indicate your office/desk location.
(This question is mandatory)

Are you currently experiencing any of the following symptoms (If you received a COVID-19 vaccine in the last 48 hours and are experiencing symptoms that only began after vaccination, select “No.”:

  • fever, 

  • sore throat, 

  • cough,

  • shortness of breath,

  • malaise (fatigue or feeling of being generally unwell),

  • runny nose, and/or

  • other symptoms of COVID-19 including but not limited to: Aches and pains, diarrhoea, conjunctivitis, headache, loss  of taste or smell or a rash on skin.

(This question is mandatory)

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.”

If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”

(This question is mandatory)

In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)?