RESIDENT ASSESSMENT TO ENTER Instructions: The following is a basic screening for Residents to follow to determine if a prospective resident can enter to view a suite based on the COVID-19 pandemic. As part of Morguard’s strategy to prevent the spread of COVID-19, we are implementing a screening process to protect the health and safety of all occupants and employees. Questionnaire Complete the following questionnaire Name: Daniel An Suite: 1017 Reason for Suite Entry: lightbulb replacement Number: 780-710-9029 Screening Fitness to Work Questionnaire 1. Are you experiencing any of the following symptoms associated with COVID-19? Yes � No � Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius or/ 100.4 degrees Fahrenheit or higher) Chills Cough 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 throat (not related to seasonal allergies or other known causes) Difficulty Swallowing Runny 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 conditions) Lost sense of taste or smell Pink eye (conjunctivitis) Headache that's unusual or long-lasting Digestive issues like nausea/vomiting, diarrhea, stomach pain (not related to other known causes or conditions) Muscle aches that are unusual or long-lasting Extreme tiredness that is unusual (fatigue, lack of appetite) Falling down often 2. To your knowledge, have you been exposed to anyone in the last 14 days who is COVID-19 positive? 3. Have you, or any members of your household travelled internationally in the last 14 days? 4. Have you been tested for COVID-19 and are awaiting results? 5. Have you tested positive for COVID-19 in the last 14 days? Yes � No � Yes � No � Yes � No � Yes � No � If they have answered “yes” to ANY of the questions, we are not permitted to enter their suite at this time. If they answered “no” to all the questions, we are welcome to enter or work in their suite. Signature: ____________________________ 02-02-2020 Date: __________________________
