Shaw Covid Screen

Daily Health Declaration - Self-Assessment

Required Screening Questions:

First Name:
Last Name:
Personal Phone#:
Department:
Visitor Company
Visitee First Name:
Visitee Last Name:

Venues where I expect to work today (check all that apply):
Annex
Cannery Warehouse
Court House
Festival
Other-Offsite
Other-Outdoor Shaw
Prop Shop
RG Gallery
Royal George
Scene Shop
Victoria St.

Do you have any of the following new or worsening signs and symptoms? Symptoms should not be chronic or related to other known causes or conditions.

Fever or chills

Yes

Difficulty breathing or shortness of breath

Yes

Cough

Yes

Sore throat, trouble swallowing

Yes

Runny nose /stuffy nose or nasal congestion

Yes

Decrease or loss of smell or taste

Yes

Unusual headache

Yes

Nausea, vomiting, diarrhea, abdominal pain

Yes

Not feeling well, extreme tiredness, sore muscles

Yes

If you answer NO to all questions you can enter the workplace.

If you answer YES to any question, you should not enter the workplace. You should go home and notify your supervisor, Shaw Guild Volunteers should notify the appropriate Guild Chair You must isolate and contact your healthcare provider or Niagararegion.ca/health (905-688-8248) to find out if you need a COVID-19 test. Follow up with your supervisor/director/Covid Compliance Manager or Human Resources before returning to work. Shaw Guild Volunteers should follow up with the appropriate Guild Chair before returning to volunteer duties or events.

I hereby declare that the details provided above are true and correct to the best of my knowledge.