Please complete the following screener prior to entering the building. If you have any of the following symptoms or have been in contact with someone who is suspected to have COVID please stay home and notify your team lead.




    What is your profession? (required)Family PhysicianRN/RPNNurse PractitionerPhysician AssistantRegistered DietitianMental Health CounsellorPharmacistPsychiatristAdmin/Clinic ManagerOther (please specify below)

    If other, please specify below:

    Do you have a fever 37.8 degrees or greater? (required)
    YesNo
    Do you have new onset cough or worsening cough or difficulty breathing? (required)
    YesNo
    Do you have one or more of the following - new or worsening symptoms? (Not attribute to any other cause) (required)
    Sore throat, hoarse voice, difficulty swallowingHeadache, runny nose, nasal congestion, sneezingNausea, vomiting, diarrhea, abdominal painMuscle aches, chills, unexplained fatigue/malaiseConjunctivitis (pink eye)None of the above
    In those 70 years or older, are you experiencing any of the following? (required)
    Delirium, acute cognitive declineUnexplained or increased number of fallsWorsening of chronic conditionsNone of the above/not applicable
    Have you traveled outside of Canada in the last 14 days? (required)
    YesNo