COVID-19 Screening Questions

Department*

Please select department.

Full Name*

Please enter your name.

Telephone Number*

Please enter your phone number.

Email*

Invalid email address.

Have you travelled outside of Canada in the past 14 Days?*

YesNo

Please select an option.

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

YesNo

Please select an option.

Have you experienced any of the below symptoms in the past 24 hours?*

Fever or chills

Difficulty breathing or shortness of breath

Cough

Sore throat, trouble swallowing

Runny nose/stuffy nose or nasal congestion

Decrease or loss of smell or taste

Nausea, vomiting, diarrhea, abdominal pain

Not feeling well, extreme fatigue, sore muscles

None of the above

Please select any symptoms experienced in the past 24 hours.