Self Assessment Tool

The information collected by this questionnaire will be used and disclosed solely for the purposes of screening for fitness for work during the COVID-19 pandemic in accordance with Sunnyside’s obligation to provide a safe work and clinical environment for all.We require you to answer the questions below at the start of each shift to assist Sunnyside in determining your fitness to work during COVID­19.

Bring a screen shot of your completed assessment to show the person taking your temperature.

We are not screening for seasonal or environmental allergies; related symptoms to these scenarios would not preclude you from work. The following screening questions are meant to capture new symptoms, or a worsening of long­standing symptoms.

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