Question Title

* 1. Are you experiencing any of the following symptoms? Click any that apply. 

Question Title

* 2. I attest that prior to coming onto the campus for working or learning purposes that I will conduct a self-check using the above list and that should I have one or more of the above symptoms I will follow the guidance from the Ontario Governments website. https://covid-19.ontario.ca/self-assessment/

Question Title

* 3. I understand that if I am sick or have one or more of the above symptoms that I must stay home or leave the NOSM campus at which I am working and follow my Supervisor’s guidance for reporting illness or requesting to work from home. In addition, I will contact my health care provider for medical guidance and follow the guidance from the Ontario Governments website.

Question Title

* 4. If within the past 14 days you were in close contact with a person who has a COVID-19 infection, stay home and follow the guidance from the COVID 19 Ontario Self-Assessment tool. 

 https://covid-19.ontario.ca/self-assessment/

Close contact includes being within approximately 6 feet of a person with confirmed COVID-19 for more than a few minutes, living with a person who has COVID-19 or having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on, sharing utensils).

Question Title

* 5. My name is:

Question Title

* 6. I work or learn in the following area:

T