COVID-19 Questionnaire COVID 19 Questionnaire Name* Please check off all the questions that you answer YES to 1. Do you have a fever or have felt hot or feverish anytime in the last two weeks (14 days)? 2. Do you have any of the following symptoms: Dry cough? Shortness of breath? Difficulty breathing? Sore throat? Runny nose? 3. Have you experienced a recent loss of smell or taste? 4. Have you been in contact with any confirmed COVID-19 positive patients, or persons self- isolating because of a determined risk for COVID-19 without proper PPE? 5. Have you returned from travel outside of Canada in the last 14 days? 6. Have you returned from travel within Canada from a location known affected with COVID-19? 7. Is your workplace considered high risk? (e.g. routine close contact with many people without proper PPE) Please Call us at 905-294-6444 if you have answered yes to any of these questions
