COVID-19 Screening FormCheck "No" to All Check1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.Fever or ChillsYesNoDifficulty breathing or shortness of breathYesNoCoughYesNoSore throat, trouble swallowingYesNoRunny nose/stuffy nose or nasal congestionYesNoDecrease or loss of smell or tasteYesNoNausea, vomiting, diarrhea, abdominal painYesNoNot feeling well, extreme tiredness, sore musclesYesNo2. Have you travelled outside of Canada in the past 14 days?YesNo3. Have you had close contact with a confirmed or probable case of COVID-19?YesNoThanks for completing the screening form! If any symptoms appear that could change your answer to any of the questions over the course of the day, please inform us immediately.Stop! You are a potential risk for COVID-19. Do not enter the workplace and return home to self-isolate immediately. Contact your healthcare provider or Telehealth Ontario at +1 866-797-0000 to determine if you require a COVID-19 test.