COVID-19 Screening Questionnaire

    Required Screening Questions

    1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

    Fever or chills YesNo

    Difficulty breathing of shortness of breath YesNo

    Cough YesNo

    Sore throat, trouble swallowing YesNo

    Runny nose, stuffy nose or nasal congestion YesNo

    Decrease or loss of smell or taste YesNo

    Nausea, vomiting, diarrhea, abdominal pain YesNo

    Not feeling well, extreme tiredness, sore muscles YesNo

    2. Have you traveled outside of Canada in the past 14 days?

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