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MANDATORY Covid-19 Daily Screening Questionnaire

As the (Covid-19) Coronavirus situation continues to evolve, Electro Cables Inc. will monitor developments closely and are taking all measures to protect the health and well-being of our employees, suppliers and clients.

Effective immediately, ALL EMPLOYEES must complete the required Screening Questionnaire before entering the plant. DO NOT submit your responses more than 2 hours before your shift.


  1. Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions.

Fever and/or Chills

Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher

YES:  NO: 

Cough or barking cough (croup)

Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have

YES:  NO: 

Shortness of breath

Not related to asthma or other known causes or conditions you already have

YES:  NO: 

Decrease or loss of smell or taste

Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

YES:  NO: 

Sore throat

Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have

YES:  NO: 

Difficulty swallowing

Painful swallowing not related to other known causes or conditions you already have

YES:  NO: 

Pink eye

Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)

YES:  NO: 

Runny or stuffy/congested nose

Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have

YES:  NO: 

Headache

Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have)

If you received a COVID-19 vaccination in the last 48 hours and are experiencing a mild headache that only began after vaccination, select “No.”

YES:  NO: 

Digestive issues like nausea/vomiting, diarrhea, stomach pain

Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have

YES:  NO: 

Muscle aches/joint pain

Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have)

If you received a COVID-19 vaccination in the last 48 hours and are experiencing a mild headache that only began after vaccination, select “No.”

YES:  NO: 

Fatigue

Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”

YES:  NO: 

Falling down often

For older people

YES:  NO: 

2.  Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

This can be because of an outbreak or contact tracing.

YES:  NO: 

3.  In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?

If you have since tested negative on a lab-based PCR test, select “No.”

YES:  NO: 

4.  In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?

If public health has advised you that you do not need to self-isolate (e.g., you are fully vaccinated* or another reason), select “No.”

YES:  NO: 

5.  In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?

If you are fully vaccinated* and/or have already gone for a test and got a negative result, select "No."

YES:  NO: 

6.  In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?

YES:  NO: 

7.  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*, select “No.”

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

YES:  NO: 

*Fully vaccinated is defined as an individual ≥14 days after receiving their second dose of a two-dose COVID19 vaccine series or their first dose of a one-dose COVID-19 vaccine series.

If you answered NO to all questions from 1 through 7, you can enter the workplace. While in the workplace, you must continue to follow all public health and workplace control measures, including masking, maintaining physical distance and hand hygiene. If you have received a COVID-19 vaccination in the last 48 hours and have mild headache, fatigue, muscle ache and/or joint pain that only began after immunization, and no other symptoms, you must wear a surgical/procedure mask for your entire shift even if not otherwise required to do so. Your mask may only be removed to consume food or drink and you must remain at least two meters away from others when the mask is removed. If your symptoms worsen, or continue past 48 hours, or you develop other symptoms, you must notify your supervisor and leave the workplace immediately to self-isolate and seek COVID-19 testing.

If you have answered YES to any questions from 1 through 7, you are not to enter the workplace. You must notify your supervisor immediately and contact Human Resources as soon as possible. You should stay home to self-isolate immediately and contact your health provider or Telehealth Ontario at (1-866-797-0000) to find out if you need a Covid-19 test.

If you have answered YES to question 7, you are not to enter the workplace. You should stay home along with the rest of your household until the sick individual gets a negative Covid-19 test result, is cleared by your local public health unit, or is diagnosed with another illness.

If your answers to these screening questions change while you are at work, you must immediately inform your Supervisor of the change and go home to self-isolate. You should contact your health care provider or Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if you need a Covid-19 test. You should also contact the Human Resources Manager as soon as possible.