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OPEN HOUSE COVID QUESTIONNAIRE

Name(Required)

Do you have any of the following new or worsening symptoms or signs?

Fever or Chills(Required)
Cough(Required)
Trouble Breathing(Required)
Sore Throat or Trouble Swallowing(Required)
Runny or Stuffy Nose(Required)
Decrease of Loss of taste or smell(Required)
Nausea, Vomiting, or Diarrhea(Required)
Pink Eye(Required)
Headache(Required)
Very Tired, Sore Muscles or Joints(Required)
Does anyone in your household have one or more of the above symptoms and/or are waiting for test results experiencing symptoms?(Required)
Have you been notified as a close contact of someone with COVID-19 or been told to stay home and self-isolate?(Required)
In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?(Required)
In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?(Required)