AreaX.O Visitor COVID Screening

Please ensure you fill out this form prior to or when you visit the Invest Ottawa Area X.O Test Facility.
Please note only fully vaccinated individuals are permitted to enter the site at this time.
We appreciate your cooperation.

Question Title

* 1. Contact Information

Full Name

Company Name

Email Address

Phone Number

Question Title

* 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.

	Yes	No
Fever or chills	Fever or chills Yes	Fever or chills No
Difficulty breathing or shortness of breath	Difficulty breathing or shortness of breath Yes	Difficulty breathing or shortness of breath No
Cough	Cough Yes	Cough No
Sore throat, trouble swallowing	Sore throat, trouble swallowing Yes	Sore throat, trouble swallowing No
Decrease or loss of taste or smell	Decrease or loss of taste or smell Yes	Decrease or loss of taste or smell No
Muscle aches and pains	Muscle aches and pains Yes	Muscle aches and pains No
Extreme tiredness, lack of energy or feeling unwell	Extreme tiredness, lack of energy or feeling unwell Yes	Extreme tiredness, lack of energy or feeling unwell No
Runny or stuffy/congested nose	Runny or stuffy/congested nose Yes	Runny or stuffy/congested nose No

Question Title

* 3. Did you answer "yes" to any of the above symptoms?

Yes