Close physical contact means: 
  • Being less than 2 metres away in the same room, workspace, or area for over 15 minutes
  • Living in the same house


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* 1. Name

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* 2. Today's Date

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* 3. Temperature

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* 4. Have you travelled outside of Ontario in the last 14 days?

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* 5. In the last 14 days, have you been in close physical contact with a person who is currently sick with a new cough, fever, or difficulty breathing?

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* 6. In the last 14 days, have you been in close physical contact with a person who returned from outside of Canada within the last 2 weeks?

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* 7. In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19?

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* 8. Are you in any of these at risk groups? Check all that apply.

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* 9. Are you currently experiencing any of these issues? Call 911 if you are. Check all that apply.

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* 10. Are you currently experiencing any of these symptoms? Check all that apply.

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