OPERATING ENGINEERS TRAINING

INSTITUTE OF ONTARIO

COVID19 SELF ASSESSMENT

I COMMIT TO:

  • Completing an accurate COVID-19 self assessment prior to each training/work session
  • Reporting any YES responses IMMEDIATELY to Members Health at 1-800-484-0152 (available 24/7)
  • Practicing social distancing, utilizing personal protective equipment (masks)

PLEASE PROVIDE HONEST ANSWERS TO THE

FOLLOWING QUESTIONS:

Are you experiencing ANY of the following symptoms?

A fever
Chills
New or worsening cough
Change or loss of sense of taste and/or smell
Nausea/vomiting, diarrhea, abdominal pain
Shortness of Breath
Runny nose or nasal congestion
New or unusual nasal congestion
Sore throat and/or pain or difficulty swallowing
Significant headache
Body aches
New joint pain
Pink eye
Unexplained fatigue
Have you travelled outside of Canada within the last 14 days?
Have you had close contact, including living in the same household, with a confirmed COVID-19 positive individual in the last 14 days?
Are any household members with who you ave had close physical contact currently being investigated for COVID-19 AND has influenza life illness (fever, body aches along with 1-2 other symptoms like cough, shortness of breath, runny nose of sore throat?
Have you had close contact with a person who has respiratory symptoms AND has travelled outside of Canada in the last 14 days?
Have you had contact with a COVID-19 positive person without the use of appropriate personal protective equipment (PPE)?
Have you downloaded the COVID Alert mobile app onto your mobile phone?
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You can do so here:

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Do you commit to immediately notifying Members Health at

Tel 1-800-484-0152 if you receive a contact alert through the

COVID Alert mobile app? *

Thanks for submitting!