COVID-19 Screening Questionnaire
1. Did you or anyone in your family travel outside of Canada in the past 14 days?
2. If you answered yes, where did you go and when did you return? If you didn't travel please write N/A
3. Have you quarantined for 14 days upon your return?
4. Have you or anyone in your family been sick or tested positive for COVID-19 or had close contact with a someone else who is sick or is a suspected or confirmed case of COVID-19?
5. Do you have any of the following symptoms now or in the last 14 days?
N/A - I am not/was not feeling sick
New onset of cough
Worsening chronic cough
Shortness of breath
Decrease of loss of sense of taste or smell
Unexplained fatigue/malaise/muscle aches (myalgias)
Nausea/vomiting, diarrhea, abdominal pain
Pink eye (conjunctivitis)
Runny nose or nasal congestion without other known cause