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COVID-19 Screening Questionnaire

    COVID Checklist

    All persons entering Ontario One Call worksites must complete and submit the checklist below prior to entering the building.

    1. Symptoms

    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

    Difficulty breathing or shortness of breath


    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

    2. Travel

    Have you travelled outside of Canada in the past 14 days?

    3. Contact

    Have you had close contact with a confirmed or probable case of COVID-19?

    Next Steps

    If you answered No to all of the questions listed above, you may enter the building.

    If you answered Yes to any of the questions listed above you MAY NOT ENTER the building. Go home to self-isolate immediately and contact your health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test.