COVID-19 Screening Form





    • YesNo

    • Did you travel outside of Canada in the past 14 days?Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?

    • Fever or chills?New onset cough or worsening chronic cough?Shortness of breath?Decrease or loss of sense of taste or smell?If adult >18 years of age: unexplained fatigue/lethargy/malaise/muscle aches (myalgias)?If child <18 years of age: nausea/ vomiting, diarrhea?None of the above

    • YesNo

    • YesNo