COVID-19 Screening Form

COVID-19 Screening Form
Name
Name
First
Last
Have you travelled outside of Canada in the last 14 days?
Has someone you are in close contact with tested positive for COVID-19in the last 14 days?
Are you in close contact with a person who is sick with new respiratory symptoms or who recently traveled outside of Canada?
Do you have a fever? (temperature ≥ 37.8 °C)
Do you have any of these symptoms?
Chills?
New or worsening cough (dry or productive)?
Barking cough (croup)?
Shortness of breath/difficulty breathing?
Sore throat?
Difficulty swallowing?
Loss of taste or smell?
Pink eye (conjunctivitis)?
Headache that is unusual or long-lasting?
Runny or stuff nose (not related to seasonal allergies or other known causes or conditions)?
Nausea/vomiting/diarrhea/abdominal pain?
Muscle aches?
Unexplained fatigue/malaise?
Falling more than usual?
If you have answered:
Are these symptoms typical for you (i.e. history of allergies, migraines, other known medical condition that usually causes these symptoms)?