Covid-19 Screening Form 

The safety, health and well-being of our employees and community members is our top priority. This screening tool is meant to keep all employees and visitors healthy. It is only a basic screening checklist and is not meant to take the place of medical advice, diagnosis or treatment.

Please follow all public health measures to help prevent the spread of COVID-19 and follow all site-specific instructions upon arrival at a City facility.

Important Safety Reminders:

• Actively monitor changes in your health each day
• Wash your hands regularly with soap and water for at least 20 seconds
• If soap and water are not available, use an alcohol-based hand sanitizer
• Practice physical distancing
• Wear a mask when required
• If you are feeling unwell, or have symptoms of COVID-19, stay home! If you are an employee, do not attend the workplace. Advise your supervisor to discuss your next steps.

This form may contain personal information as defined under the Municipal Freedom of Information and Protection of Privacy Act. This information is collected under the legal authority of the Municipal Act, 2001, S.O. 2001 c.25, as amended. This information will be used and maintained by the City of Oshawa to screen City employees and visitors to City facilities for signs and symptoms of COVID-19, in accordance with Ontario Regulation 364/20 Schedule 1 Section 2(3). Questions regarding this collection may be directed to the City’s Information Access and Privacy Officer, City of Oshawa, 50 Centre Street South, Oshawa, Ontario, L1H 3Z7, 905-436-3311.