Newfoundland & Labrador
This questionnaire is intended for staff and physicians to assist with ensuring our safety in monitoring our own health, and potential risks for COVID-19.

Please answer the following questions before attending work each day/shift.

Please complete the form below and click the Continue button to register your self-assessment.

Please select your RHA/NLCHI.

Those who are infected with COVID-19 may have little to no symptoms. You may not know you have symptoms of COVID-19 because they are similar to a cold or flu.

Do you have two or more of the following new or worsening symptoms:

  • Fever greater than 38° Celsius (or signs of a fever such as chills, sweats, muscle aches and light-headedness)
  • Cough
  • Headache
  • Sore throat
  • Painful Swallowing
  • Runny nose
  • Unexplained loss of appetite/diarrhea
  • Loss of sense of smell or taste
  • Chilblain-like lesions on feet and/or hands (small, red or purple spots on hands and/or feet)
A response is required

For residents of the Atlantic Provinces (New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador), have you traveled outside of these provinces within the last 14 days?

And/OR

For residents of communities along the Labrador-Quebec border (Labrador City, Wabush, Fermont, the Labrador Straits area and Blanc Sablon), have you traveled outside of these areas of Quebec in the last 14 days?

  • Note: If you are a non-resident of the Atlantic Provinces and have approval (i.e., a travel exemption, or an approval for extenuating circumstances from the Chief Medical Officer of Health and have completed the 14-day self-isolation) to live/work/visit the Province of Newfoundland and Labrador, please answer the question above for residents.
A response is required

In the past 14 days have you had close contact with a confirmed case of COVID-19 outside the workplace?

A response is required

In the past 14 days have you had close contact with a confirmed case of COVID 19 in the workplace or in a different workplace, where you were not wearing PPE?

A response is required

Have you reported it to management, contacted Occupational Health, and received appropriate direction from Occupation Health to return to and/or remain at work?

A response is required