COVID SCREENING HomeCOVID SCREENING COVID 19 Screening Form COVID 19 health screening to be completed at SOS. Name* Date* MM slash DD slash YYYY Time* : Hours Minutes Health Screening AssessmentTemperature* Temperature (Celsius) must be obtained prior to entering any of the crew area(s) of Brighton Volunteer Ambulance.Are you been experiencing any of the following signs/symptoms of COVID 19?* Fever/Chills Muscle/General Body Aches Fatigue Chest Pain Nausea/Vomiting/Diarrhea Cough/Chest Pain Loss of smell/taste None If you are experiencing any of the following signs/symptoms please don source control and contact the Operations Supervisor for further instructions prior to entering the ambulance base. Have you been exposed to anyone with a confirmed COVID 19 diagnosis in the last 14 days without source control?* Yes No Have you tested positive for COVID 19 in the last ten (10) days?* Yes No Results Pending If you are currently pending the results of a COVID 19 test please contact the Operations Supervisor for further instructions.