COVID Questionaire
1. Are you experiencing any or all of Mild to moderate shortness of breath or Inability to lie down because of difficulty breathing or Chronic health conditions that you are having difficulty managing because of difficulty breathing or Having a very hard time waking up or Feeling confused? *
2. Are you experiencing cold, flu or COVID-19-like symptoms, even mild ones? *
• Symptoms include: fever, chills, cough, shortness of breath, sore throat and painful swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue or loss of appetite.
3. Have you travelled to any countries outside Canada (including the United States) within the last 14 days? *
4. Did you provide care or have close contact with a person with confirmed or suspected COVID-19? *
** A close contact is defined as a person who: • Provided care for the individual, including healthcare workers, family members or other caregivers, or who had other similar close physical contact with the person without consistent and appropriate use of personal protective equipment • Lived with or otherwise had close prolonged contact (with 2 meters) with the person while the person was infectious • Had direct contact with infectious bodily fluids of the person (eg. Was coughed or sneezed on) while not wearing recommended personal protective equipment
5. Have you been in close contact with someone who had cold, flu or COVID-19 symptoms *
• Symptoms include: fever, chills, cough, shortness of breath, sore throat and painful swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue or loss of appetite.
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