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COVID Screening Form
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Do you have a fever?
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Do you have any of the following signs or symptoms?
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Difficulty breathing
New loss or decrease in sense of taste or smell
Runny nose
Sneezing (not allergy related)
Hoarse voice
Nasal congestion
Chills
Difficulty swallowing
Headache
Unexplained fatigue or malaise
Nausea/vomiting, diarrhea, abdominal pain
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Have you been in contact with anyone with COVID-19, acute respiratory illness, or travelled outside of Canada in the past 14 days?
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Did you wear the required PPE according to the type of duties you were performing when you had close contact with a suspected or confirmed case of COVID-19?
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