Settings
Time zone
(UTC-12:00) International Date Line West
(UTC-11:00) Coordinated Universal Time-11
(UTC-10:00) Hawaii
(UTC-09:00) Alaska
(UTC-08:00) Tijuana, Baja California
(UTC-08:00) Pacific Time (US and Canada)
(UTC-07:00) Arizona
(UTC-07:00) Chihuahua, La Paz, Mazatlan
(UTC-07:00) Mountain Time (US and Canada)
(UTC-06:00) Central America
(UTC-06:00) Central Time (US and Canada)
(UTC-06:00) Guadalajara, Mexico City, Monterrey
(UTC-06:00) Saskatchewan
(UTC-05:00) Bogota, Lima, Quito
(UTC-05:00) Eastern Time (US and Canada) (Form default)
(UTC-05:00) Indiana (East)
(UTC-04:00) Asuncion
(UTC-04:00) Atlantic Time (Canada)
(UTC-04:00) Caracas
(UTC-04:00) Manaus
(UTC-04:00) Georgetown, La Paz, San Juan
(UTC-04:00) Santiago
(UTC-03:30) Newfoundland and Labrador
(UTC-03:00) Brasilia
(UTC-03:00) Cayenne
(UTC-03:00) Buenos Aires
(UTC-03:00) Montevideo
(UTC-02:00) Coordinated Universal Time-02
(UTC-02:00) Greenland
(UTC-02:00) Mid-Atlantic
(UTC-01:00) Azores
(UTC-01:00) Cape Verde Is.
(UTC) Coordinated Universal Time
(UTC) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London
(UTC) Monrovia, Reykjavik
(UTC) Casablanca
(UTC+01:00) Amsterdam, Berlin, Bern, Rome, Stockholm, Vienna
(UTC+01:00) Belgrade, Bratislava, Budapest, Ljubljana, Prague
(UTC+01:00) Brussels, Copenhagen, Madrid, Paris
(UTC+01:00) Sarajevo, Skopje, Warsaw, Zagreb
(UTC+01:00) West Central Africa
(UTC+02:00) Athens, Bucharest, Istanbul
(UTC+02:00) Beirut
(UTC+02:00) Cairo
(UTC+02:00) Minsk
(UTC+02:00) Harare, Pretoria
(UTC+02:00) Helsinki, Kyiv, Riga, Sofia, Tallinn, Vilnius
(UTC+02:00) Jerusalem
(UTC+02:00) Windhoek
(UTC+03:00) Amman
(UTC+03:00) Baghdad
(UTC+03:00) Kuwait, Riyadh
(UTC+03:00) Moscow, St. Petersburg, Volgograd
(UTC+03:00) Nairobi
(UTC+03:30) Tehran
(UTC+04:00) Abu Dhabi, Muscat
(UTC+04:00) Baku
(UTC+04:00) Port Louis
(UTC+04:00) Tbilisi
(UTC+04:00) Yerevan
(UTC+04:30) Kabul
(UTC+05:00) Tashkent
(UTC+05:00) Ekaterinburg
(UTC+05:00) Islamabad, Karachi
(UTC+05:30) Chennai, Kolkata, Mumbai, New Delhi
(UTC+05:30) Sri Jayawardenepura
(UTC+05:45) Kathmandu
(UTC+06:00) Astana
(UTC+06:00) Dhaka
(UTC+06:30) Yangon (Rangoon)
(UTC+07:00) Bangkok, Hanoi, Jakarta
(UTC+07:00) Krasnoyarsk
(UTC+07:00) Novosibirsk
(UTC+08:00) Beijing, Chongqing, Hong Kong S.A.R., Urumqi
(UTC+08:00) Irkutsk
(UTC+08:00) Kuala Lumpur, Singapore
(UTC+08:00) Perth
(UTC+08:00) Taipei
(UTC+08:00) Ulaanbaatar
(UTC+09:00) Osaka, Sapporo, Tokyo
(UTC+09:00) Seoul
(UTC+09:00) Yakutsk
(UTC+09:30) Adelaide
(UTC+09:30) Darwin
(UTC+10:00) Brisbane
(UTC+10:00) Canberra, Melbourne, Sydney
(UTC+10:00) Guam, Port Moresby
(UTC+10:00) Hobart
(UTC+10:00) Vladivostok
(UTC+11:00) Magadan, Solomon Is., New Caledonia
(UTC+12:00) Auckland, Wellington
(UTC+12:00) Coordinated Universal Time+12
(UTC+12:00) Fiji Is., Marshall Is.
(UTC+12:00) Petropavlovsk-Kamchatsky
(UTC+13:00) Nuku'alofa
(UTC+13:00) Midway Island, Samoa
No
No
No
Infection Prevention and Control Staff Screening Tool
Please only complete if you are submitting antigen testing results AND/OR have symptoms OR a known high-risk COVID-19 exposure.
Are you a Niagara Health employee with a valid email address? For example:
firstname.lastname@niagarahealth.on.ca
or
mnemonic@niagarahealth.on.ca
Yes
No
Please enter your Niagara Health email address
Please re-enter your Niagara Health email address
Please complete the following information
First Name
Last Name
Department
Email Address
Are you a student?
Medical
General
Please select which Hospital Site you are reporting to
*
NFS
WS
SCS
FES
PCS
Data Centre
Niagara Falls Satellite Dialysis Centre
Withdrawal Management Services, St. Catharines
1. Are you a NH staff or physician and required to complete a COVID-19 at-home antigen test 48 hours before your shift?
Yes
No
Test Date
12 AM
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Next Shift Date
12 AM
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Test Result
Positive
Negative
Antigen testing information is for Occupational Health data collection reasons only and not shared with other parties
2. Do you have symptoms of fever, cough, sore throat, loss of taste or smell, diarrhea?
*
Yes
No
I acknowledge and confirm that the information provided above is truthful and accurate:
*
A confirmation email will be sent to the email provided above after submitting the form.
You are unable to report to work.
Staff/Physicians only
please complete KICS Triaging form located
here
. Problems accessing KICS, please call 905-378-4647 ext. 44273
You are unable to report for work. Please email this message to NHClinicalTeaching@niagarahealth.on.ca and call Medical Affairs at 905-378-4647 extension 44225.
You are unable to report to placement. Please email this message to NH Student Screening at NHStudentScreening@niagarahealth.on.ca.
You are unable to report for work and must self-isolate. Please email this message to your manager and immediately call Occupational Health at ex 44273 for further follow-up.
You are still able to report to work. Please wear a mask at all times.
Staff/Physicians only
please complete KICS Triaging form located
here
. Problems accessing KICS, please call 905-378-4647 ext. 44273
You are able to report to work. Please email this message to NHClinicalTeaching@niagarahealth.on.ca and call Medical Affairs at 905-378-4647 extension 44225 as soon as you arrive in your department. Wear a mask at all times.
You are able to report to placement. Please email this message to NH Student Screening at NHStudentScreening@niagarahealth.on.ca.
Please show this message to your manager/supervisor, charge person, or a colleague in your department.
Please show this message to your Clinical Instructor or Preceptor.