Guild Group response to Covid-19...
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Covid-19 Screening Form
Name
*
Contact (Phone Number or Email)
*
Date
*
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Location to be Accessed
*
Do you have any of the following new or worsening symptoms or signs?
Symptoms should not be chronic or related to other well known causes or conditions.
Fever or Chills?
*
Yes
No
Difficulty breathing or shortness of breath?
*
Yes
No
Cough?
*
Yes
No
Sore throat, trouble swallowing?
*
Yes
No
Runny nose, Stuffy nose or nasal congestion?
*
Yes
No
Decrease in loss of smell or taste?
*
Yes
No
Nausea, vomiting, diarrhea, abdominal pain?
*
Yes
No
Not feeling well, extreme tiredness, sore muscles?
*
Yes
No
Have you traveled outside of Canada in the past 14 days?
*
Yes
No
Have you had close contact with a confirmed or probable case of COVID-19?
*
Yes
No