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MANDATORY Covid-19 Daily Screening Questionnaire

Version 12 – February 4, 2022

This screening tool provides advice, recommendations and instructions issued by the Office of the Chief Medical Officer of Health in accordance with subsection 2(3), Schedule 1 of O. Reg. 364/20: Rules for Areas at Step 3 and at the Roadmap Exit made under the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020 (ROA).

Anyone who is sick and has any symptom(s) of illness that are not listed in this screening tool, should stay home until they do not have a fever, their symptom(s) are improving for over 24 hours (48 hours for gastrointestinal symptoms), and seek assessment from their health care provider, if needed.

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. In the last 10 days have you experienced any of the symptoms below?

If you are fully vaccinated and not immune compromised and experienced the symptom(s) over 5 days ago and the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and you do not have a fever, select “No.”

If you are unvaccinated or immune compromised and experienced the start of symptom(s) over 10 days ago and the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and you do not have a fever, select “No”

If you are symptomatic and tested negative for COVID-19 on a single PCR test or two rapid antigen tests (RAT) taken 24-48 hours apart and symptoms have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and you do not have a fever, select “No”

For symptom(s) that are new, worsening or different from an individual’s baseline health, select “Yes”. Otherwise, symptom(s) should not be chronic or related to other known causes or conditions. The symptoms listed here are the symptoms most commonly associated with COVID-19. If you have these symptoms, you should isolate and contact your health care provider, take a self-assessment, visit a clinical assessment centre, or call Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if you need a COVID-19 test, if eligible.

Do you have one or more of the following symptoms?
YES:   NO:  
Fever and/or chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup) Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have
Shortness of breath Not related to asthma or other known causes or conditions you already have
Decrease or loss of smell or taste Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

  2. In the last 10 days have you experienced any of the symptoms below?

If you are fully vaccinated and not immune compromised and experienced the symptom(s) over 5 days ago and the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and you do not have a fever, select “No.”

If you are unvaccinated or immune compromised and experienced the start of symptom(s) over 10 days ago and the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and you do not have a fever, select “No”

If you are symptomatic and tested negative for COVID-19 on a single PCR test or two rapid antigen tests (RAT) taken 24-48 hours apart and symptoms have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and you do not have a fever, select “No”

For symptom(s) that are new, worsening or different from an individual’s baseline health, select “Yes”. Otherwise, symptom(s) should not be chronic or related to other known causes or conditions.

Do you have one or more of the following symptoms?
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
Sore throat Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)
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 and/or flu vaccination in the last 48 hours and are only experiencing a mild headache that only began after vaccination, select “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 and/or flu vaccination in the last 48 hours and are only experiencing mild muscle aches/joint pain that only began after vaccination, select “No.”
Fatigue Unusual tiredness, 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 and/or flu vaccination in the last 48 hours and are only experiencing mild fatigue that only began after vaccination, select “No.”
Nausea, vomiting and/or diarrhea Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have

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

YES:  NO: 

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

Staying at home/self-isolation can be because of an outbreak or contact tracing.

YES:  NO: 

5.  In the last 10 days, have you tested positive for COVID-19?

If you are fully vaccinated and not immune compromised and the test was more than 5 days ago, select “No”.

This includes a positive COVID-19 test result on a lab-based PCR test, rapid antigen test or a home-based self-testing kit.

YES:  NO: 

6.  Do any of the following apply?

  • You live with someone who is currently isolating because of a positive COVID19 test
  • You live with someone who is currently isolating because of COVID-19 symptoms
  • You live with someone who is waiting for COVID-19 test results

If you tested positive for COVID-19 (on a lab-based PCR test, rapid antigen test, or home-based self-testing kit) within the last 90 days and have already completed your isolation period, select “No”.

YES:  NO: 

7.  In the last 10 days, have you been identified as a "close contact" of someone who currently has COVID-19?

If you are fully vaccinated and not immune compromised, select “No”

If you tested positive for COVID-19 (on a lab-based PCR test, rapid antigen test, or home-based self-testing kit) within the last 90 days and have already completed your isolation period, select “No”.

YES:  NO: 

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ELECTRO CABLES

9 Riverside Drive
P.O. Box 276
Trenton, Ontario
CANADA K8V 5R5

N.A. Toll Free: 888-ELECTRO
(1-888-353-2876)

World: 613-394-4896

Fax: 613-394-4101

Email: sales@electrocables.com

We manufacture cables that are certified by the Canadian Standards Association (CSA), listed by Underwriters Laboratories and/or listed by Intertek (ETL).

Our quality management system is registered to ISO 9001: 2015. Our team is dedicated to consistently providing quality service and products to our customers.

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