Required fields are marked with asterisks (*)

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COVID-19 Screening Tool - Visitors

The COVID-19 Screening Form will be used to screen visitors for symptoms of COVID-19.

This check list provides basic information only. It is not intended to take the place of medical advice, diagnosis or treatment. 

This Form must be completed before entry into a municipal facility.

  • Everyone in your household must stay home if anyone has COVID-19 symptoms or is waiting for test results after experiencing symptoms.
  • Stay home until the person with symptoms gets a negative COVID-19 test result, or is cleared by public health, or is diagnosed with another illness.
Visiting Facility
Please select on of the following:
 
Symptoms List
Fever and/or chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup) Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have
Shortness of breath Not related to asthma or other known causes or conditions you already have
Decrease or loss of smell or taste Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

(For adults ≥ 18 years or older)

 Fatigue, lethargy, malaise and/or myalgias

Unusual tiredness, 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.”

 

1. Are you currently experiencing one or more of the symptoms above that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions.
 
2. 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.
 
3. 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.”
 
4. In the last 14 days, have you been identified as a “close contact” of someone who has currently had COVID-19? If public health has advised you that you do not need to self-isolate (e.g., you are fully vaccinated or another reason), select “No.”
 
5. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you are fully vaccinated and/or have already gone for a test and got a negative result, select “No.”
 
6. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements? If you are not fully vaccinated and you live with someone who travelled outside of Canada, see Note below.
 
7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If you are fully vaccinated, select “No.”
 

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



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