Covid-19 Health Screening Tool

The information collected in this questionnaire will be used and disclosed information solely for the purposes of determining fitness for work during the COVID-19 pandemic in accordance with SRI Homes – Kelowna (SRI) obligations to provide a safe environment for SRI Staff and contractors.  We require you to fill out the below questionnaire to assist SRI in determining your fitness to work. Ensure at all times you are following protocols for hand hygiene and also remember to clean your keys, phone, computers and other personal items.  We understand that people may have season or environmental allergies. Related symptoms to these scenarios would not preclude them form work. The following questions are meant to capture new symptoms, or a worsening of long-standing symptoms.  In the event I or a member of my household test positive for Covid 19, I agree to allow SRI Homes – Kelowna to use my personal information to trace my contact history with my coworkers.

  • Are you experiencing or have you experienced in the past 10 days any of the following symptoms: fever, cough, headache, fatigue, muscle aches, chills, loss of appetite, shortness of breath, loss of sense of smell, stuffy or runny nose, sore throat and painful swallowing.
  • This field is for validation purposes and should be left unchanged.