Daily COVID-19 Screening

Please take this self-assessment prior to coming to the clinic each day to determine if you were exposed to COVID-19 (novel coronavirus) or have symptoms.

Results of Screening Questions:
• If you answer NO to all questions from 1 through 3, you have passed and can enter the clinic.
• If you answer YES to any questions from 1 through 3, you have not passed and should not enter the clinic (including any outdoor, or partially outdoor, workplaces). You should go home to self-isolate immediately and contact your health care provider or the South West Public Health Unit @ (519) 631-9900 to find out if you need a COVID-19 test.

Thanks for helping keep all of us and our families safe.

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* 1. Your Name

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* 2. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

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* 3. Have you travelled outside of Canada in the past 14 days?

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* 4. Have you had close contact with a confirmed or probable case of COVID-19?

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