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Name:
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Employee Number:
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Branch:
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1. Does the employee have acute respiratory illness with sudden onset of a least ONE of the following: cough, sore throat, shortness of breath, or fever (>=38C or history of fever) AND
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2. In the 14 days prior to onset of symptoms, met at least ONE of the following criteria;
- a. Were in close contact:
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with a confirmed or,
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probable case, of COVID-19, (i.e. you are a primary contact) OR transmission of COVID-19, OR
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b. Had a history of travel to areas with presumed ongoing community transmission of COVID-19, OR
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3. Has the employee been in close contact with a person who has symptoms of COVID-19, who has been tested, but results are not available yet (i.e. you are a possible primary contact), OR
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4. Has the employee been in contact with a primary contact (i.e. you are the secondary contact).
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