COVID 19 survey questions

1. Are you fully vaccinated against COVID-19?

Yes No

2. Are you currently experiencing any of the COVID 19 symptoms, ex: Fever, Shortness of breath, cough, decrease or loss sense of taste or smell?

Yes No

3. Is anyone you live with currently experiencing any new COVID-10 symptoms and/or waiting for test results after experiencing symptoms?

Yes No

4. In the last 14 days, have you travelled outside of Canada and been told to quarantine?

Yes No

5. Has a doctor, health care provider, or public health unit told you that you should currently be isolating(staying at home)?

Yes No

6. In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19?

Yes No

7. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?

Yes No

8. In the last 14 days, have you tested positive on a rapid antigen test or home-based self-testing kit?

Yes No

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