WFOL – Volunteer COVID Screening

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. Have you traveled outside of the country in the last 14 days?*

Yes
No

1. Comments

2. Have you been in close contact** with anyone who has acute respiratory illness and has traveled outside the country in the last 14 days?*

Yes
No

2. Comments

3. Has someone you are in close contact with tested positive for COVID-19?*

Yes
No

3. Comments

4. Do you live with someone who is awaiting COVID-19 test results who 1): was tested due to symptoms OR 2) was tested due to close contact with someone who test positive?*

Yes
No

4. Comments

5. Are you experiencing any of the following symptoms: fever/chills, new cough or cough getting worse, difficulty breathing, shortness of breath (even when sitting or walking regularly) sore throat, a runny or congested nose (not allergies), usual level of fatigue, unusual headache, nausea/vomiting, diarrhea or loss of appetite, feeling unwell for any unknown reason*

Yes
No

5. Comments

** Close contact is defined as a person who provided care for the patient, including healthcare workers, family members or other caregivers, or who had similar close physical contact OR who lived with or otherwise had close prolonged contact with a probable or confirmed case while the case was ill.

You have answered YES to any of Questions 1, 2, 3 or 4. Do not attend work at any Niagara Parks location. Self-isolate for 14-days.

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

You have answered YES to Question 5. Remain home and contact Niagara Public Health (905.688.8248) or your health care provider. You can also take the self assessment available on the Province's website. Follow the direction provided by a health care professional and keep in contact with your Supervisor/Manager regarding the direction.

Please click "Submit" to complete the questionnaire.

Volunteer COVID-19 Screening Questionnaire

AWAY YOU GO!

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