Friendly Fires Covid-19 Screening Form

Completion of this COVID-19 screening form is required for admittance to a Friendly Fires location for team members. Your answers will be used to generate a pass / fail response. 

If you receive a fail response, please do not enter any Friendly Fires location without speaking to the local public health unit or your Manager.

    Questions

    1. Have you tested positive on a COVID-19 Rapid Antigen or PCR test, or awaiting results in the last 5 days if fully vaccinated (or 10 days if partially or unvaccinated)?

    2. Have you been directed by Public Health, a physician or other healthcare professional to self-isolate for a period of time including today?

    3. Do you have any of the following new or worsening, signs or symptoms?
    Any one of the following:*

    • Fever, chills, croup (squeaky or whistling nose when breathing)
    • Severe difficulty breathing or shortness of breath
    • Decrease or loss of taste or smell
    • Nausea, vomiting, diarrhea, abdominal pain

    And two of: *

    • Stuffy, congested or runny nose
    • Headache* that is unusual or long lasting
    • Fatigue that is unusual
    • Sore throat, hoarse voice or difficulty swallowing

    4. If you are not fully vaccinated, have you been in close contact with anyone (including household members) who has tested positive for COVID-19 in the past 5 days ? Close contact means being less than 2 meters (6 feet) away in the same area for at least 10 minutes or physical contact such as shaking hands, hugging, or being coughed on, sneezed on.


    If you answered NO to all questions you may enter the workplace. Inside of the workplace, you must continue to follow all public health and workplace control measures, including masking and maintaining physical distance, where applicable. Personal information is collected under the authority of Municipal Act, 2001, S.O. 2001, c. 25.