Screening form

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 and/or chills

Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher.

Yes

No

Cough or barking cough (croup)

Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have.

Yes

No

Shortness of breath

Not related to asthma or other known causes or conditions you already have.

Yes

No

Decrease or loss of taste or smell

Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

Yes

No

Fatigue, lethargy, malaise and/or myalgias (For adults > 18 years or older)

Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”

Yes

No

Nausea, vomiting and/or diarrhea (For children < 18 years)

Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have

Yes

No

In the last 14 days, have you travelled outside of Canada and been advised to quarantine as per the federal quarantine requirements?

Yes

No

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

This can be because of an outbreak or contact tracing.

Yes

No

In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19?

If public health has advised you that you do not need to self-isolate (e.g., you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been cleared), select “No.”

Yes

No

In the last 10 days, have you received a COVID Alert exposure notification on your cell phone?

If you are have already gone for a test and got a negative result, select "No." If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."

Yes

No

In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?

If you have since tested negative on a lab-based PCR test, select “No.”

Yes

No

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”

If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select No.”

Yes

No

COVID Screening