MAG Canada Visitor COVID-19 Screening Questionnaire

Please use the form below to complete your Visitor COVID-19 Screening Questionnaire.

Todays Date:

Name:

Base Location

If you answer “Yes” to any of questions above, please DO NOT enter the MAG Canada facility. Please contact your supervisor or the Operations Manager. You are not permitted to return until clearance from COVID-19 has been issued. Please contact your local Public Health office or Telehealth for more guidance.

If you answer “NO” to all the above, you may enter the MAG Canada facility as long as you follow public health guidelines and the procedures listed in the MAG Canada COVID Plan.

Are you currently experiencing any of these symptoms?

Fever and/or chills
Cough or barking cough (croup)
Shortness of breath
Decrease or loss of taste/smell
Muscle aches or joint pain (not related to vaccine in the last 48 hours)
Extreme tiredness (not related to vaccine in the last 48 hours)

In the last 14 days, have you travelled outside of Canada?

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit?

Screening Questions – Additional Screening for Employees/Visitors Who Are Not Fully Vaccinated

Answer these added questions if you are not fully vaccinated. Fully vaccinated means it has been 14 days or more since your final dose of either a two-dose or a one-dose vaccine series.

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19?

In the last 10 days, have you received a COVID Alert exposure notification on your phone?

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