COVID 19 Screening Questionnaire


Have you experienced any of the following symptoms in the last 14 days: Cough (new onset or worsening of chronic cough), shortness of breath, loss of sense of smell and/or taste, chills, fever (100.4F/38C), chills, muscle aches in relationship to the symptoms, runny nose, sore throat, nausea or vomiting, diarrhea?
In the past 14 days, have you been advised to get tested for COVID-19 and/or quarantine/self-isolate in accordance with public health and/or government requirements/guidance or been exposed to anyone who has been advised to do the same?
Have you been in contact with anyone in the past 14 days who has been advised to quarantine/self-isolate in accordance with public health and/or government requirements/guidance?
Have you been exposed to Covid-19 within the last 14 days?
If you answered YES to the above, please describe your exposure history
Have your been strictly adhering to the Federal and Provincial requirements associated with reducing the spread of COVID?19 for at least the last 14 days?
I confirm that I / employee is fully vaccinated. If no, please contact Algoma a covid19screening@algonet.com as you may not be permitted to board
By typing your name below, you affirm the information in this questionnaire to be accurate.