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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. 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 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)

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

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

YES:  NO: 

Extreme tiredness

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

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)?

YES:  NO: 

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

YES:  NO: 

4.  In the last 14 days, have you received a COVID Alert exposure notification on your cell?
If you already went for a test and got a negative result, select "No".

YES:  NO: 

5.  In the last 14 days, have you or anyone you live with travelled outside of Canada?
If you or anyone you live with are exempted from federal quarantine as per Group Exemptions, Quarantine Requirements under the Quarantine Act, select "No".

YES:  NO: 

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

YES:  NO: 

If you answered NO to all questions from 1 through 6, you can enter the workplace. If you have answered YES to any questions from 1 through 6, you are not to enter the workplace. 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.

It is your responsibility to inform your Supervisor if you are unwell. Please also call Human Resources Manager as soon as possible to discuss the situation.