Covid Weekly Screening : Fort McMurray SDA Church Fort McMurray AB

Participant’s Name

Phone

Email

Today’s Date and Activity Start Time:

Do you have a Fever (greater than 38.0C)

Cough

Shortness of Breath/Difficulty Breathing

Sore Throat

Chills

Painful swallowing

Runny Nose/Nasal Congestion

Feeling unwell/Fatigued

Nausea/ Vomiting/ Diarrhea

Unexplained loss of appetite

Loss of sense of taste or smell

Muscle / Joint aches

Headache

Conjunctivitis

2. Have you, or anyone in your household travelled outside of Canada in the last 14 days?

3. Have you or your children attending the program had close unprotected contact (face-to-face contact within two-meters) with someone who is ill with cough and/or fever?

4. Have you or anyone in household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?

1: Do you have any of the below symptoms?