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Covid-19 Self Screening Form
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Email
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Your email
Rider Name
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Your answer
Lesson Date
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Required Screening Questions
1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions
Yes
No
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 tiredness, sore muscles
Yes
No
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 tiredness, sore muscles
Clear selection
Have you traveled outside of Canada in the past 14 days?
Yes
No
Clear selection
3. Have you had close contact with a confirmed or probable case of COVID-19?
Yes
No
Clear selection
Results of Screening Questions
If you answered NO to all questions from 1 through 3, you have passed screening and are permitted to visit the facility. See you at your lesson! Please remember face masks are required other than while mounted.
If you answered YES to any questions from 1 through 3, you are not permitted to visit the facility and Ontario Public Health advises that you should self-isolate immediately and contact your health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test.
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