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Staff/Professional Staff COVID-19 Self-Screen Tool

COVID-19 Self-Screening Application

In accordance with Directive #2 for Health Care Providers issued under s. 77.7 of the Health Protection and Promotion Act (HPPA), Trillium Health Partner’s requires all staff, professional practice and volunteers to complete the following screening questionnaire in order to manage and monitor COVID-19 infections at THP sites, and specifically:

  1. identify individuals who are at risk of testing positive for COVID-19;
  2. enhance Trillium Health Partners’ ability to efficiently screen at all THP sites;
  3. test, screen and monitor staff who identify as having symptoms;
  4. contract tracing for confirmed COVID-19 individuals; and
  5. plan, evaluate and research the efficiency and efficacy of the application and responses.

By completing the screening, you are attesting that the information given in the form is true and accurate and agree that the information may be used at a later time for the purposes above. Should you have any questions regarding the collection and use of this information, contact the Privacy Office at