ArcelorMittal
493825038692100Daily Screen Check SheetPlease validate that you have reviewed the following information and confirmation of status screening. Employee Name:Click or tap here to enter text.Employee Signature:Date:Supervisor name:I have been in contact with anyone with new respiratory symptoms (fever, cough or difficulty breathing)I have travelled outside of Canada in the past 14 days. I have had close contact with a confirmed case of COVID-19.Do you have any of the following symptoms? FeverCough that’s new or worsening (continuous, more than usual)Barking cough, making a whistling noise when breathing (croup)Shortness of breath (out of breath, unable to breathe deeply)Sore throatDifficulty swallowingLoss sense of taste or smellChillsHeadache that’s unusual or long lastingMuscle aches that are unusual or long lastingExtreme tiredness that is unusual (fatigue, lack of energy)Digestive issues like nausea/vomiting, diarrhea, stomach pain (not related to other known causes or conditionsPink eyeRunny nose (not related to seasonal allergies or other known causes or conditions)Stuffy or congested nose (not related to seasonal allergies or other known causes or conditionsFalling down oftenYes NoYes NoIf you answered Yes to any of the above questions you are not authorized to attend work and should follow up with your local Public Health for further guidance.Reviewed by Supervisor: ................
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