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CodeCore College - Wellness Check-in Form
This form is to be completed by CodeCore College Staff and Students twice weekly on Mondays and Thursdays
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* Indicates required question
Name
*
Your answer
Address
*
Your answer
Phone Number
Your answer
Arrival Date in Canada (Skip, if not applicable to you)
MM
/
DD
/
YYYY
End of Quarrantine Date (Skip, if not applicable to you)
MM
/
DD
/
YYYY
In the last few days, I have developed the following symptoms:
*
Dry Cough
Weakness or Fatigue
Difficulty Breathing
Sore Throat
Fever
Chills
Muscle Aches or Headaches
None of the above
Required
In the last few days, I have tested positive for Covid-19.
*
Yes
No
I have been tested but I have not received my results
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