Employee COVID Survey Oakridge Ford 601 Oxford St W, London, ON N6H 1T8 Required Screening Questions Do you have any of the following new or worsening symptoms or signs? Symptomsshould not be chronic or related to other known causes or conditions - Step 1 of 5Name *FirstLastEmailDate / TimeDateTimeNextFever or chills *YesNoDifficulty breathing or shortness of breath *YesNoCough *YesNoNextSore throat, trouble swallowing *YesNoRunny nose/stuffy nose or nasal congestion *YesNoDecrease or loss of smell or taste *YesNoNextNausea, vomiting, diarrhea, abdominal pain *YesNoNot feeling well, extreme tiredness, sore muscles *YesNoNextHave you travelled outside of Canada in the past 14 days? *YesNoHave you had close contact with a confirmed or probable case of COVID-19? *YesNoCommentSubmit
