COVID-19 Self-Screening Tool

One (1) form requires per person. Form with the multiple names will be invalid.

Do you have any of the following new or worsening symptoms or signs?

• Fever and/or Chills
• Cough or Barking cough
• Shortness of breath
• Decrease or loss of smell or taste
• Extreme tiredness or muscle aches

Please read the following questions:

• Has a doctor, health care provider, or public health unit told you that you should currently be isolating (Staying at home)?
• Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
• In the last 14 days,
  1. Have you or anyone you live with travelled outside of Canada? (per federal quarantine requirements)
• In the last 10 days,
  1. Have you been identified as a "close contact" of someone who currently has Covid-19
  2. Have you tested positive on a rapid antigen test or home-based self-testing kit?
  3. Have you received a COVID Alert exposure notification on your cell phone? (Not applicable if you already went for a test and got a negative result)