Ontario Home Health Covid-19 Screening

Ontario Home Health Covid-19 Screening Tool

Ontario Home Health is taking all measures to protect our staff, clients and communities from the spread of Covid-19. You are being asked to complete this brief screening too prior to your appoint with our team.

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* 1. What is your name:

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* 2. What is the date:

Date / Time

Date

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* 3. Have you been in contact with a known or suspected case of Covid-19?

Yes

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* 4. Have you been tested for Covid 19 in the last 14 days?

Yes

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* 5. Have you traveled outside of Canada in the last 30 days?

Yes

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* 6. Do you have any of the following symptoms?

Fever

New onset of cough

Worsening chronic cough

shortness of breath

Runny nose or nasal congestion without other known cause

Headache

Vomiting, Nausea or Diarrhea

Pink eye

Chills

None of the above