Finest Sausage & Meat Ltd.

COVID-19 QUESTIONNAIRE

Name

First Last

Current Time*

:

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 or chills*

YES
NO

Difficulty breathing or shortness of breath*

YES
NO

Cough*

YES
NO

Sore throat, trouble swallowing*

YES
NO

Runny nose/stuffy nose or nasal congestion*

YES
NO

Decrease or loss of smell or taste*

YES
NO

Nausea, vomiting, diarrhea, abdominal pain*

YES
NO

Not feeling well, extreme tiredness, sore muscles*

YES
NO

2. Have you travelled outside of Canada in the past 14 days?

Have you travelled outside of Canada in the past 14 days?*

NO, I have NOT travelled outside of Canada
YES, I have travelled outside of Canada

DUE TO YOUR ANSWERS, YOU WILL NOT be permitted to enter the Factory. Please call 519-748-9003 to discuss.

COVID

COVID-19 QUESTIONNAIRE

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