1. In the last 10 days, have you or a household member tested positive on a COVID-19 rapid antigen test, a self-testing kit or PCR test?

2. Have you been directed by Public Health, a physician or other healthcare professional to self-isolate for a period of time including today?

3. Do you have any of the following new or worsening, signs or symptoms?

Any one of:

Fever or chills
Fever and/or chills
Cough, croup (squeaky or whistling nose when breathing),
Severe difficulty breathing or shortness of breath
Severe chest pains
Loss of consciousness
Feeling confused or unsure of where you are
Not feeling well
Falling down often
Pink eye
Decrease in or loss of smell or taste
Headache* that is unusual or long lasting
Lack of appetite

Any two of:

Stuffy, congested or runny nose
Headache* that is unusual or long lasting
Runny Nose / Nasal Congestion
Fatigue* that is unusual, lack of energy or sluggishness
Sore throat, hoarse voice or difficulty swallowing
Muscle aches or joint pain* that is unusual or long lasting
Digestive issues (nausea/vomiting, diarrhea or stomach pain)

**If you received a COVID-19 vaccination or booster in the last 48 hours and are experiencing mild headache, mild muscle ache, mild joint pain, and/or mild fatigue that began after vaccination, and have no other symptoms, then you can answer NO for question 3.

4. Is anyone in your household currently required to self-isolate due to COVID-19 positive test results or symptoms?

5.In the last 10 days, have you had close contact* with someone who has or is suspected of having COVID-19 (including exhibiting any of the listed symptoms** and/or awaiting test results)? If you are fully vaccinated (received the full series of a Canada-approved COVID-19 vaccine at least 14 days ago) and have not been advised to self-isolate by Public Health, you may select ‘NO’ to Question 4

*Close contact means being less than 2 metres or 6 feet away in the same area for at least 10 minutes, living in the same home or physical contact such as shaking hands, hugging, being coughed on, sneezed on, spit on or receiving a exposure notification from the COVID-19 Alert exposure app.

**If the individual experiencing symptoms was vaccinated or received booster in the last 48 hours
and is experiencing mild headache, mild muscle or joint ache, and/or mild fatigue and the symptoms
started after vaccination, then you can answer “NO” to Question 4.

6. Have you travelled outside of Canada in the past 14 days and been advised to quarantine in accordance with the Government of Canada quarantine requirements?