COVID-19 Self-Assessment

 

Name

full name

Location

select one


Do you have any of the following that are new, worsening and not related to other known causes or conditions:

Fever

Temperature >37.8C

Cough

that's new or worsening, continuous, more than usual, not related to other known causes or conditions (ie. COPD)

Shortness of breath

out of breath or unable to breathe deeply, out of breath or unable to breathe deeply, not related to other known causes or conditions (ie. asthma)

Sore throat

not related to other known causes or conditions (ie. seasonal allergies, acid reflux)

Runny nose

not related to other known causes or conditions (ie. seasonal allergies, being outside in cold weather)

Feeling unwell

select one

Have you been in close physical contact with someone who tested positive for COVID-19 in the past 14 days?

select one

Have you returned from travel outside Northwestern Ontario or Northern Manitoba in the past 14 days?

select one

Comments


If you answered yes to any of these questions you should: contact your Team Leader immediately; stay home and take the self-assessment on your Provincial Government website to help you determine your next steps.