COVID19 Screening

Northern Lights Ford | COVID19 Screening






Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions?
  • Fever and/or Chills
  • Cough or barking cough (croup)
  • Shortness of breath
  • Decrease or loss of smell or taste
  • For adults 18 years or older: Fatigue, lethargy, malaise and/or myalgias
  • If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”
  • For people less than 18 years old: Nausea, vomiting and/or diarrhea.
    YesNo
    • In the last 14 days, have you traveled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?
    YesNo
    Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
    YesNo
    In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19? If public health has advised you that you do not need to self-isolate (e.g. you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared), select "No.
    YesNo
    In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? If you have already gone for a test and got a negative result, select “No.” If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No".
    YesNo

    In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? If you have since tested negative on a lab-based PCR test, select "No."
    YesNo

    Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select "No." If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
    YesNo

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