Health Screening Questionnaire

The following must be read by or to an employee or worker seeking access to a BCIB workplace.

This is a daily health check screening assessment and applies to all employees, workers and contractors seeking access to a BCIB-controlled workplace. A workplace daily health check and confirmation is required by Order of the Provincial Health Officer dated December 16, 2020.

Anyone who refuses to participate in the daily health check will be denied access to BCIB-controlled workplaces – without exception.

Are you feeling well today? As an important first step please be advised that any employee who is feeling unwell in any way should stay at home and not enter a BCIB workplace until they are feeling better or they are otherwise medically cleared to return. The following screening queries also apply.

Please do not enter this workplace if you:

  • Have travelled outside of Canada within the last 14 days
  • Have been identified by Public Health as a close contact of someone with COVID-19
  • Have been told to isolate by Public Health

Are displaying any of the following new or worsening symptoms:

  • Fever or chills
  • Extreme fatigue or tiredness
  • Cough
  • Headache
  • Loss of sense of smell or taste
  • Body aches
  • Difficulty breathing
  • Nausea or vomiting
  • Sore throat
  • Diarrhea
  • Loss of appetite

If you are displaying symptoms consistent with COVID-19, please contact HealthLink BC by calling 811.

In order to be permitted access to a BCIB-controlled workplace, YOU ARE REQUIRED TO:

  1. CONFIRM below that none of the prohibited criteria apply to you; AND,
  2. RECEIVE CONFIRMATION from a BCIB Representative THAT YOU HAVE PASSED the daily health check PRIOR TO ENTRY to a BCIB-controlled workplace.
Please select a valid form