COVID-19 Screening Tool
To comply with recommendations outlined by the Chief Medical Officer of Health for Ontario, all employees,
contractors, students and volunteers coming to Victoria University to perform work are required to complete
the following COVID-19 screening process each time they arrive on campus. Please submit this completed
document to your Manager.
Required Screening Questions
1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be
chronic or related to other known causes or conditions.
Difficulty breathing or shortness of breath
Cough
Sore throat, trouble swallowing
Runny nose/stuffy nose or nasal congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
Have you travelled outside of Canada in the past 14 days?
Yes No
3. Have you had close contact with a confirmed or probable case of COVID-19?
Yes
No
Results of Screening Questions:
• If you answered NO to all questions from 1 through 3, you can enter the workplace.
• If you answer YES to any questions from 1 through 3, be advised that you should not enter the
workplace. You should stay home to self-isolate immediately and call your Manager. You should
contact your health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a
COVID-19 test. Victoria University employees should also notify Human Resources by emailing
vic.hr@utoronto.ca
.
Employee Name:
Department:
Date:
