Health Waiver 

Have you returned from travel outside Canada in the past 14 days? Have you returned from travel outside Canada in the past 14 days? Yes No

Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days? Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days? Yes No

In the last 14 days have you been in close physical contact with someone who returned from outside of Canada in the last 2 weeks with new COVID-19 symptoms (like a cough, fever, or difficulty breathing)? In the last 14 days have you been in close physical contact with someone who returned from outside of Canada in the last 2 weeks with new COVID-19 symptoms (like a cough, fever, or difficulty breathing)? Yes No

Have your household contacts presented with new COVID-19 symptoms (like a cough, fever, or difficulty breathing) in the last 14 days? Have your household contacts presented with new COVID-19 symptoms (like a cough, fever, or difficulty breathing) in the last 14 days? Yes No

Do you have any of the following symptoms? (Select all that apply) Do you have any of the following symptoms? (Select all that apply) Fever (temperature 37.8°C/100.0°F or higher) Chills Cough not related to other known causes or conditions (for example, asthma) Decrease or loss of smell or taste (new olfactory or taste disorder) not related to other known causes or conditions, (for example, nasal polyps, allergies, neurological disorders) Sore throat (painful swallowing or difficulty swallowing) not related to other known causes or conditions; (for example, post nasal drip, gastroesophagal (acid) reflux) Stuffy nose and/or runny nose,(nasal congestion and/or rhinorrhoea) not related to other known causes or conditions (for example seasonal allergies, returning inside from the cold, chronic sinusitis unchanged from baseline, reactive airways) Headache that is new and persistent, unusual, unexplained, or long-lasting not related to other known causes or conditions (for example, tension-type headache, chronic migraines) Nausea, vomiting and/or diarrhea, not related to other known causes or conditions Fatigue, lethargy, muscle aches or malaise (general feeling of being unwell, lack of energy, extreme tiredness) that is unusual or unexplained, not related to other known causes or conditions (for example, depression, insomnia, thyroid disfunction, anemia) No Symptoms

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