WFOL - Volunteer - Covid-19 Screening Questionnaire

Screening Questions

This questionnaire has been created to ensure the health and safety of volunteers at Niagara Parks and to prevent the spread of COVID-19. The questions from this questionnaire must be answered daily by volunteers.

1. Are you currently experiencing one or more of the symptoms below not due to previously known conditions diagnosed by health care professional? (Fever/chills, cough or barking cough, decrease/loss of taste or smell, shortness of breath (even when sitting or walking regularly), or fatigue? If under 18, the above symptoms apply as well as digestive issues like nausea/vomiting, diarrhea, or stomach pain**)*

Yes
No

1. Comments

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

Yes
No

2. Comments

3. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?*

Yes
No

3. Comments

4. In the last 10 days, have you been identified as a “high-risk contact” *** of someone who currently has COVID-19? If you are fully vaccinated and have not been advised to self-isolate by public health, select “No”.*

Yes
No

4. Comments

5. In the last 10 days, have you received a COVID Alert exposure notification on your cell? If you already went for a test and got a negative result, select “No.”*

Yes
No

5. Comments

6. Have you traveled outside of the country in the last 14 days AND been advised to quarantine per the federal quarantine requirements?*

Yes
No

6. Comments

7. In the last 14 days, has someone in your household travelled outside of Canada AND been advised to quarantine as per the federal quarantine requirements? If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No”.*

Yes
No

7. Comments

8. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/ or joint pain that only began after vaccination, select “No”. If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No”.*

Yes
No

8. Comments

9. In the last 10 days, has someone in your household been identified as a “close contact” of someone who currently has COVID-19 AND has been advised by a doctor, healthcare provider or public health unit to self-isolate? If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No”.*

Yes
No

9. Comments

10. Are you required to participate in the antigen testing program AND has it been more than 48 hours since your last test? If you answer 'Yes', please send your test result to your supervisor via text or email prior to your shift. If your test result is positive, DO NOT attend the workplace.*

Yes
No

10. Comments

** If a person has received a COVID-19 vaccination in the last 48 hours and has mild headache, fatigue, muscle ache and/or joint pain that only began after immunization, and no other symptoms, the worker must wear a surgical/procedure mask for their entire shift at work even if not otherwise required to do so. Their mask may only be removed to consume food or drink and must remain at least two metres away from others when their mask has been removed. If the symptoms worsen, continue past 48 hours, or if they develop other symptoms, they should leave work immediately to self-isolate and seek COVID-19 testing.

*** A high-risk contact is defined as being within two metres of the infectious person (48 hours from start of symptoms) for 15 minutes or more or having direct physical contact with them. A contact may still be high-risk even with less than 15 minutes of close contact, or being further than two metres away, if certain aspects apply, please contact your local Public Health.

You have answered YES to any of Questions 1 through 9. Remain home or leave immediately and contact Niagara Public Health 905-688-8248 or your health care provider. You have three options available to you: 1) Quarantine for 14 days, 2) Get a COVID-19 Test or 3) Contact Niagara Public Health or health care provider for further direction.

Please click "Submit" to complete the questionnaire. Your Supervisor/Manager will provide you with further instructions.

You have answered YES to Question 10. Please send your test result to your supervisor via text or email prior to your shift. If your test result is positive, DO NOT attend the workplace.

Please click "Submit" to complete the questionnaire.

Winter Festival of Lights – Volunteer COVID-19 Screening

Volunteer COVID-19 Screening Questionnaire

Winter Festival of Lights – Volunteer COVID-19 Screening

Volunteer COVID-19 Screening Questionnaire

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