Employee Screening Form
This screening tool provides advice, recommendations and instructions issued by the Office of the Chief Medical Officer of Health in accordance with subsection 2(3), Schedule 1 of O. Reg. 364/20: Rules for Areas at Step 3 and at the Roadmap Exit made under the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020 (ROA).
The person responsible for a business or organization that is permitted to be open must ensure that workers, whether or not they are fully vaccinated against COVID-19, are actively screened for COVID-19 before they go to work or start their shift each day. Individuals who have provided proof of vaccination are still subject to the workplace screening requirements as set out under O. Reg. 364/20. For the purposes of this document, please refer to the Ministry of Health’s COVID-19 Fully Vaccinated Status in Ontario document for the definition of “fully vaccinated” where applicable in this document.
This screening tool is not to be used as a clinical assessment tool or intended to take the place of medical advice, diagnosis, treatment or legal advice. In the event of any conflict between this document and any applicable legislation, or orders or directives issued by the Minister of Health or the Chief Medical Officer of Health, the legislation, order or directive prevails.
Anyone who is sick and has any symptom(s) of illness that are not listed in this screening tool, should stay home until they do not have a fever, their symptom(s) are improving for over 24 hours (48 hours for gastrointestinal symptoms), and seek assessment from their health care provider, if needed.
The questions in this tool have been defined by the Ministry of Health. These questions can be adapted to meet the communication needs of people with learning, developmental or cognitive disabilities.
This screening tool is not applicable to some settings such as, long-term care homes or retirement homes, other congregate living settings, schools and child care where existing screening requirements and tools are already in place.
Screening is not required for emergency services or other first responders entering a workplace for emergency purposes.
Active screening must take place before the worker enters the premises of the business or organization. This screening tool can be completed either online before going to work or on-site before starting the shift or workday. Screening should occur before or immediately upon arrival at the workplace at the beginning of the worker’s shift or workday to minimize interactions with others. The employer must ensure that screening occurs, and the result of screening is used to determine whether the worker may enter the workplace.
A worker may only enter the workplace if they have passed the screening. Any worker who enters the workplace must continue to follow all public health and workplace control measures, including masking, maintaining physical distance and hand hygiene, where applicable.
Anyone who does not pass screening must not enter the workplace and be advised that they should self-isolate, ideally at home, and call their health care provider, visit a clinical assessment centre, or call Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if you need a COVID-19 test, if eligible.
Check the note at the bottom of the form prior to submission to see whether you should stay home or come to work/school, based on your answers.