COVID-19 Screening Questionnaire

In the last 14 days, have you travelled outside of Canada? *

Yes

No

Have you experienced new or worsening symptoms related to COVID- 19? *

This includes: fever or chills, difficulty breathing or shortness of breath, cough, sore throat, trouble swallowing, runny nose/stuffy nose or nasal congestion, decrease or loss of smell or taste, nausea, vomiting, diarrhea, abdominal pain, not feeling well, extreme tiredness, sore muscles.

Yes

No

Have you had close contact with a confirmed or probable case of COVID-19? *

Yes

No