COVID-19 Screening Tool reopeningri.com | health.ri.gov/covid REOPENING RI Recommended tool to screen employees, clients, and/or visitors for symptoms of COVID-19. Are you having shortness of breath or any difficulty breathing? It is not to be used They can also be used for other activities. o The questionnaire may be administered in various formats (e.g., in-person, over the Have you had close contact with a confirmed or probable case of COVID-19 without wearing appropriate PPE? Transmission of COVID-19 COVID-19 is easily spread in respiratory droplets by coughing or sneezing. _____ 2. By signing below, I acknowledge that I have filled out this form voluntarily and have a full understanding of the information contained therein. This tool provides basic information only and contains recommendations for businesses or organizations for COVID-19 screening as per . This health screening applies to all trades, suppliers, union reps, employees, etc. COVID-19 Screening Questionnaire 1. 2.) is being investigated or confirmed to be positive for COVID-19? Newly experienced any of the following symptoms that cannot otherwise be 1..attributed to another condition? Yes No ⢠fever > 38°C or think you have a fever or chills ⢠cough ⢠sore throat/ hoarse voice ⢠shortness of breath/ breathing difficulties ⢠loss of taste or smell COVID-19 HEALTH SCREENING TOOL. I also agree that all the information provided is accurate to the best of my knowledge. _____ visitors for onsite meetings should provide this questionnaire to each individual visitor sufficiently in advance so as to minimize inconveniences (travel, expenses, etc.). Ontario Regulation 364/20. o Conduct the screening in a format that makes sense for your establishment. Visitor Health Screening Questionnaire (COVID-19) At U. S. Steel, safety is our primary core value. The following questions are used to screen for COVID-19 before entry into a workplace (business or organization) as per Ontario Regulation 364/20. ADHA COVID-19 PATIENT SCREENING QUESTIONNAIRE *Indicate Yes or No and provide relevant comments. Yes No Yes No Fever or chills Runny/stuffy nose By ⦠_____ 2. REV: March 21, 2020 1 . As the outbreak of the coronavirus disease 2019 (COVID-19) Do you have a cough? Yes No . Screening Questionnaire and conduct symptom monitoring every day before entering CCAC buildings and facilities. 1. An ofï¬cial publication of the State of Rhode Island Have you been in close contact (less than six feet) with anyone with COVID-19 or symptoms of COVID-19 Do you have chills or repeated shaking with chills? o It can be a questionnaire, with specific questions to help identify if an individual is reporting possible symptoms of COVID-19 or recent exposure to COVID-19. COVID-19 Screening Tool for Workplaces (Businesses and Organizations) Version 1 â September 25, 2020 . Patient Name: Date: Do you have a fever, or have you felt feverish recently? COVID ⦠Employees can self-screen in advance of work and on site. Version 6 . Have you or has anyone in your house been tested for COVID-19 coronavirus in the past 14 days? Guidelines: To prevent the spread of COVID-19 and to reduce the potential risk of exposure to the workforce, please conduct this questionnaire, daily, at designated entry points, prior to accessing the site. To reduce the risk of spread of COVID-19 in the workplace, employees should be screened prior to entering work. COVID-19 SCREENING QUESTIONNAIRE Date Time Name Birth Year Gender male femaleother B. COVID-19 Risk Assessment Tool As you use this risk assessment tool, including the simple questionnaire at the end, the following four words should guide you: People, Space, Time, and Place. No Yes If YES, 1. What the date of your test? 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