COVID-19 Patient Screening Tool

First Name *

Last Name *

Email *

Contact Number

2. Have you been in close contact in the last 14 days with someone that is confirmed to have COVID-19? *

3. Have you had close contact with a person who developed fever, cough or shortness of breath that started within 14 days? *

4. Have you returned to Canada from outside the country (including USA) in the past 14 days? *

5. Have you had close contact with a person who has travelled outside of Canada within 14 days? *

6. Has a member of your household been identified as a close-contact and instructed to self-isolate (quarantine) by public health officials, and they are not able to isolate from you? *