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