COViD-19 Declaration For safety reasons, we are screening everyone wishing to enter our sites for COVID-19 Name*FirstLast Email* Phone* ARE YOU A *CLIENTVISITORSTAFF 1. Have you or anyone you have had contact with travelled outside of Canada in the past 14 days?*YESNO 2. Have you had close contact with a confirmed case of COVID-19?YESNO 3. Have you been informed you are/have been COVID-19 positive?*YESNO 4. Do you have new / worsening cough?*YESNO 5. Do you have shortness of breath / difficulty breathing?*YESNO 6. Have you had fever (37.8 or greater) in the last 48 hours?*YESNO 7. Do you have: (Response is YES if 1 or more)*FatigueChillsHeadachesSore throatNausea/vomitingLoss of sense of taste or smellPink EyeDiarrheaAbdominal painDifficulty swallowingRunny nose or nasal congestionNONE OF THE ABOVEMuscle achesRapid heart rate 8. In the last 14 days, have you received a COVID Alert exposure notification on your cell? If you already went for a test and got a negative result, select “No.”YESNOSubmitReset
