Form Test Health Assessment Form Name * Date * Site Location * Health Monitoring Are you feeling unusually tired or sore today? YesNo Do you know if or feel like you have a fever? YesNo Do you have a cough? YesNo Are you having a hard time breathing? YesNo Do you feel like you might be coming down with a cold or the flu? YesNo Is anyone in your household currently sick with a cold or flu? YesNo Have you travelled outside of Canada via plane, train or cruise ship in the last 14 days? YesNo Have you been in close contact with anyone that has been confirmed to have COVID-19? YesNo
