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Health Screening Form

Do you have any of these symptoms?

  • Fever
  • New onset of cough
  • Worsening of chronic cough
  • Shortness of breath
  • Difficulty breathing
  • Sore throat
  • Difficulty swallowing
  • Decrease or loss of sense of taste or smell
  • Chills
  • Unexplained headaches
  • Unexplained fatigue, malaise, muscle aches
  • Nausea/vomiting, diarrhea, stomach pain
  • Eye pain or pink eye (conjunctivitis)
  • Runny nose or stuffy nose without known cause
  • Have you traveled in an airplane, and/or outside of Canada in the last 14 days?
  • Have you been in close contact with someone who has a confirmed case of COVID-19 (for example: someone in your household, or workplace).
  • Have you been in close contact with a person who is sick with respiratory symptoms (fever, cough, or difficulty breathing) who has recently traveled outside of Canada?

 Please complete this form within the 24 hour period before you enter the building.

Sat, September 18 2021 12 Tishrei 5782