TPM GUEST COVID-19 SELF-ASSESSMENT FORM

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Before entering the TPM building you need to complete the self-assessment below.

We appreciate you taking the time with our safety protocols. Please remember that we are putting these in place in order to continue doing theatre with the current health and safety recommendations and to keep yourself, and the staff of TPM safe. Thank you for your patience.

Email *

The safety of everyone who comes through our doors is a community commitment. I agree to follow the articulated protocols to the best of my ability and to respect other people's comfort levels in engagement. As well, since Toronto is no longer able to do contact-tracing, I understand that the responsibility relies on the individual to report any COVID symptoms in order to protect the community at large. *

I Agree

Required

1. Have you returned from travel outside Canada in the past 14 days? If exempt from federal quarantine requirements (for example, you are fully vaccinated and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.” *

Yes

2. Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days? *

Yes

3. Do you have any of the following symptoms? Select all that apply: *

Shortness of breath, out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)

Fever and/or chills (hot to the touch or above 38/100.4)

Cough or barking cough (croup). Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)

Muscle aches/joint pain. Unusual, long-lasting (not related to getting a COVID-19 vaccine in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)

Decrease or loss of taste or smell, not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

Extreme tiredness. Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

I do not have any symptoms

Required

If you answered YES to one or more of the questions, please do not enter the building.

Contact our COVID-19 Compliance Officer who will inform you of the next steps.
complianceofficer@passemuraille.on.ca

You can also reach out to our Box Office at 416-504-7529

Thank you for your dedication to keep yourself and everyone at Theatre Passe Muraille safe.

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Telehealth (Telephone: 1-866-797-0000)

Toronto Public Health Hotline
8:30 a.m. – 8 p.m.
Call if you have questions about COVID-19. Translation is available in multiple languages.
Telephone: 416-338-7600
TTY: 416-392-0658
Email: PublicHealth@toronto.ca
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