COVID-19 Screening - Swim Camp 2 Question Title * 1. Name(s) of Individual(s) entering the Facility? Question Title * 2. Date/Time of Entry ? Date / Time Date Time AM/PM - AM PM Question Title * 3. Do you and/or anyone in your household have any of the following? Fever / Chills New cough or a cough that has worsened Difficulty breathing Shortness of breath Sore throat A runny or congested nose Unusual level of fatigue Unusual headache Nausea, vomiting, diarrhea, or loss of appetite None of the above Question Title * 4. Have you or anyone in your household been in close contact with someone who has tested positive for COVID-19? Yes No Question Title * 5. Have you or anyone in your household returned from travel outside of Canada in last the 14 days? Yes No Question Title * 6. Are you or someone in your household waiting for COVID-19 test results? Yes No Done
