Required Screening Questions

Please fill out this form each day upon arrival.

Full Name

Your Email

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

Fevers or Chills?
YesNo

Difficulty breathing or shortness of breath?
YesNo

Cough?
YesNo

Sore throat, trouble swallowing?
YesNo

Runny nose/stuffy nose or nasal congestion?
YesNo

Decrease or loss of smell or taste?
YesNo

Nausea, vomiting, diarrhea, abdominal pain?
YesNo

Not feeling well, extreme tiredness, sore muscles?
YesNo

2) Have you travelled outside of Canada in the last 14 days?
YesNo

3) Have you had close contact with a confirmed or probable case of COVID19?
YesNo

4) Are you ready to have a great day?!?!
YesNo

Your Signature:
Use your mouse to sign on computer, or finger on a mobile device