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COVID-19 Screening Checklist
Do you have any of the following new or worsening symptoms or signs?
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* Indicates required question
Fever
*
Yes
No
Required
Cough
*
Yes
No
Difficulty Breathing
*
Yes
No
Required
New loss of taste or smell
*
Yes
No
Required
Nausea/vomiting, diarrhea, or abdominal pain
*
Yes
No
Required
Runny nose or nasal congestion
*
Yes
No
Required
Red eyes (conjunctivitis/pink eye)
*
Yes
No
Required
Not feeling well, tired or sore muscles
*
Yes
No
Required
Have you travelled outside of Canada in the past 14 days?
*
Yes
No
Required
Have you been in close contact with a confirmed or probable case of COVID-19?
*
Yes
No
Required
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