COVID-19 Pre-Screening Questionnaire

COVID-19 Pre-Screening Questionnaire

*mandatory information

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* 1. Please enter your full name?

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* 2. Please fill in your contact phone number

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* 3. Please select your date of arrival to Farewell Harbour Lodge

Date

Date

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* 4. Are you experiencing symptoms of a cough, fever, or having difficulty breathing

Yes

No

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* 5. Are you experiencing chills, fatigue, headache, sore throat, runny nose, stuffy or congested nose, lost sense of taste or smell, hoarse voice, difficulty swallowing or any digestive issues (nausea/vomiting, diarrhea, stomach pain)

Yes

No

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* 6. Have you been in close contact with a confirmed or probable case of COVID-19 in the last 14 days?

Yes

No

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* 7. Have you travelled outside of Canada or been in contact with someone who has in the last 14 days?

Yes

No

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* 8. Are you currently under mandatory quarantine, as a result of recent travel or orders from the provincial, territorial or local public health authorities?

Yes

No