COVID-19 Screening Checklist

 

Are you currently experiencing any of the following symptoms?
Fever YES NO
Cough YES NO
Shortness of Breath / Difficulty Breathing YES NO
Sore Throat YES NO
Chills YES NO
Painful Swallowing YES NO
Runny Nose / Nasal Congestion YES NO
Feeling Unwell / Fatigued YES NO
Nausea / Vomiting / Diarrhea YES NO
Unexplained Loss of Appetite YES NO
Loss of Sense of Taste or Smell YES NO
Muscle / Joint Aches YES NO
Headache YES NO
Conjunctivitis YES NO
Have you, or anyone in your household, traveled outside of Canada in the last 14 days? YES NO
Have you, or anyone in your household, had close, unprotected contact with someone who is ill with cough and/or fever? YES NO
Have you, or anyone in your household, been in close, unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? YES NO