COVID-19 Screening Form

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I have NOT had close contact with anyone with an acute respiratory illness or travelled outside Ontario in the last 14 days? *

• I agree

I have NOT had a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19? *

• I agree

I am NOT currently experiencing any of the following symptoms: fever, shortness of breath, chills, difficulty swallowing, unexplained fatugue, muscle aches, pink eye, new onset of cough, difficulty breathing, sore throat, decrease or loss of sense of taste or smell, unexplained headaches, nausea/vomiting, diarrhea, abdominal pain and runny nose without another known cause. *

• I agree

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