COVID Screening Please fill out the form below before starting your shift today. Email Date: 2021-02-24 17:32:47 First Name * Last Name * Which restaurant are you working for today? * Amano Kitchen - Newmarket Amano Pasta - Toronto Uncle Ray's - Hamilton Uncle Ray's - Toronto Union Chicken - Newmarket Union Chicken - Sherway Gardens Union Chicken - Union Station Do you have any of the following: Fever * Yes No Cough * Yes No Difficulty Breathing * Yes No Sore throat, trouble swallowing * Yes No Runny nose * Yes No Loss of taste or smell * Yes No Not feeling well * Yes No Nausea, vomiting, diarrhea * Yes No Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days? * Yes No Have you returned from travel outside Canada in the past 14 days? * Yes No If you answered YES to any of these questions, go home & self-isolate right away. Call Telehealth or your health care provider, to find out if you need a test.