covid-19 form

1. 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.

Do you have one or more of the following symptoms?

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”.

(For children < 18 years) Nausea, vomiting and/or diarrhea
Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have.

2. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?

3. 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.

4. 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”

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

If you 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”

6. 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”

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