COVID Screening

Have you tested positive for COVID-19 in the last 21 days or have you been told that you should be tested?
YesNo

Fever (over 38°C or 100.4°F)
YesNo

New cough or worsening chronic cough
YesNo

Breathing difficulties (e.g., shortness of breath, difficulty speaking)
YesNo

Sudden loss of smell (with or without loss of taste)
YesNo

Muscle pain, headache, intense fatigue or significant loss of appetite
YesNo

Sore throat
YesNo

Diarrhea
YesNo

Do you have a health issue that might explain the symptoms described above?
YesNo

Have you been in close contact (at least 15 minutes at less than 2 metres) with a confirmed or suspected case of COVID-19?
YesNo