Point Pelee Karting Club Covid-19 Screening Form

You are required to complete this screening prior to entering the grounds regardless of if you are an employee or visitor.

This information will only be used for screening purposes and to support contact tracing efforts, if required by the local public health authority.

This result is no longer valid if your situation changes during the day (for example, you start experiencing symptoms).
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Name *
Email *
Phone number *
What is the purpose of your visit today? *
Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions. 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 *
In the last 14 days, have you or anyone you lived with travelled outside of Canada? *If exempt from quarantine requirements (for example, an essential worker who crosses the Canada-US border regularly for work), select “No.” *
Have you had close contact with a confirmed or probable case of COVID-19? *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? *If you already went for a test and got a negative result, select “No.” *
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
Did you answer yes to any of the above questions? *
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