Covid19 Screening

EN2 COVID-19 Screening Form

This form is mandatory prior to entering any facility, project, or jobsite owned and operated by EN2 Development Corp. Completion is required.

If your results determine you are able to enter the premises – please do.

If your results determine you should not be allowed to enter the premises – please safely leave the location and contact and EN2 staff member directly or by calling 1-800-354-1362.

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Name

First Last

Today's Date

MM slash DD slash YYYY

Phone

Job Site Address

Company you are representing

How old are you(Required)

We collect this anonymous information to ask age-specific questions.

17 years old or younger

18 years old or older

Do any of the following apply to you?

I am fully vaccinated against COVID-19 (it has been 14 days or more since your final dose of either a two-dose or a one-dose vaccine series)(Required)

Yes

Are you currently experiencing any of these symptoms?

Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.(Required)

Fever and/or chills

Cough or barking cough (croup)

Shortness of breath

Decrease or loss of taste or smell

Nausea, vomiting, and/or diarrhea

None of the above

In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)?(Required)

Yes

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?Untitled(Required)

This can be because of an outbreak or contact tracing

Yes

In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit?(Required)

If you have since tested negative on a lab-based PCR test, select "No."

Yes

YOU MUST CLICK THE SUBMIT BUTTON FOR VALIDATION

Submit This Form Below For Your Records

Do Not Enter The Work Site

Based on your answers, you either have symptoms or may have been exposed to COVID-19.

We recommend that you stay home to protect the health and safety of others. You could be carrying and spreading the virus without knowing it.

If anyone has symptoms or is waiting for test results

Everyone in your household who is not fully vaccinated must stay home if anyone has COVID-19 symptoms or is waiting for test results after experiencing symptoms.

Stay home until the person with symptoms gets a negative COVID-19 test result, or is cleared by public health, or is diagnosed with another illness.

Next steps

You should isolate (stay home) and not leave except to get tested or for a medical emergency
Talk with a doctor/health care provider or call Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if you need a COVID-19 test
Retake this screening before going to a business or public place, or if your situation changes today

Health and safety tips

Keep a distance of at least 2 metres from people you do not live with
Make sure you wear a face covering or mask while indoors (and outdoors when you cannot physically distance) and that it covers your mouth, nose, and chin
Wash or sanitize your hands often

Get the COVID-19 vaccine

Vaccines are safe, effective, and the best way to protect you and those around you from COVID-19 and its variants.

Learn about our COVID-19 vaccination program

YOU MUST CLICK THE SUBMIT BUTTON FOR VALIDATION

Submit This Form Below

Then You May Enter The Work Site

Health and safety tips

Keep a distance of at least 2 metres from people you do not live with
Make sure you wear a face covering or mask while indoors (and outdoors when you cannot physically distance) and that it covers your mouth, nose, and chin
Wash or sanitize your hands often

Get the COVID-19 vaccine

Vaccines are safe, effective, and the best way to protect you and those around you from COVID-19 and its variants.

Learn about our COVID-19 vaccination program