Mandatory COVID-19 Screening Questionnaire

Name(Required)
1-Do you have a fever?(Required)
2- Do you have any of the following signs or symptoms?(Required)
3. Have you travelled or have had close contact with anyone who has travelled in the past 14 days?(Required)
4. Have you had close contact with anyone with respiratory illness or a confirmed or probable/suspected case of COVID-19?(Required)
5. Did you wear the required and/or recommended PPE according to the type of duties you were performing (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures when you had close contact with a suspected or confirmed case of COVID-19?
MM slash DD slash YYYY

Disclaimer: Please note that the information on this website and provided during our sessions and seminars are not intended to diagnose, treat, cure or prevent any disease. This information is given strictly for educational purposes. In no way should the information in this website and in our sessions and seminars be considered a substitute for competent medical care by your physician or other healthcare professional.

Avertissement: Veuillez noter que les informations sur ce site Web et fournies lors de nos séances et séminaires ne sont pas destinées à diagnostiquer, traiter, guérir ou prévenir une maladie. Ces informations sont données uniquement à des fins éducatives. En aucun cas, les informations sur ce site Web et durant nos séances ou séminaires ne doivent être considérées comme un substitut aux soins médicaux compétents par votre médecin ou un autre professionnel de la santé.