Covid-19 Screening Form

Your Information


For individuals who are 18 years of age and older


Are you currently experiencing any of these symptoms?

Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.
Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
Painful swallowing (not related to other known causes or conditions you already have)
Painful swallowing (not related to other known causes or conditions you already have)
Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have
Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)
Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have)
Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have
Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have)
Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
For older people


If exempt from quarantine requirements (for example, an essential worker who crosses the Canada-US border regularly for work), select “No.”


This can be because of an outbreak or contact tracing.

If you already went for a test and got a negative result, select “No.”