wp-forms – Dawn Staffing Solutions Inc

Name *

First

Last

Email *

Do any of the following apply to you? I am fully vaccinated against COVID-19 (it has been 14 days or more since your final dose of either a two-dose or a one-dose vaccine series) I have tested positive for COVID-19 in the last 90 days (and since been cleared) The reason we ask this question is to give you a result with accurate isolation instructions. We do not collect personal health information in this tool. *

Yes
No

Are you currently experiencing any of these issues? Call 911 if you are. Severe difficulty breathing (struggling for each breath, can only speak in single words) Severe chest pain (constant tightness or crushing sensation) Feeling confused or unsure of where you are Losing consciousness *

Yes
No

How old are you? We collect this anonymous information to better understand how the virus affects different age groups. Screening a child younger than 18? Use the COVID-19 school screening to get recommendations that are more specific for children (younger than 18 years old). *

What are the first 3 characters of your postal code? The first 3 characters only tell us your general area and not your street name or number. We use them to find nearby testing locations for you. Postal code (X1X) *

Are you currently experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions you already have. The symptoms listed here are the most commonly associated with COVID-19. Anyone who is sick or has any symptoms of illness, including those not listed below, should stay home and seek assessment from their health care provider if needed. *

Fever and/or chillsTemperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup)Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
Shortness of breathOut of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
Decrease or loss of taste or smellNot related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
Muscle aches/joint painUnusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
Extreme tirednessUnusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
None of the above

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, select “No.”

Yes
No

In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? If you already went for a PCR test and got a negative result, select "No."

Yes
No

Have you been in close physical contact (while not wearing the appropriate personal protective equipment) with someone you don’t live with who either: is sick with symptoms associated with COVID-19 (listed below) in the last 10 days? or returned from outside of Canada in the last 14 days? Children (17 years old or younger): fever and/or chills, cough or barking cough, shortness of breath, decrease or loss of taste or smell, nausea, vomiting and/or diarrhea Adults (18 years old or older): fever and/or chills, cough or barking cough, shortness of breath, decrease or loss of taste or smell, tiredness, muscle aches If the person with symptoms got a COVID-19 vaccine and/or flu shot in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”

Yes
No

In the last 14 days, have you travelled outside of Canada?If exempt from federal quarantine requirements (for example, you are fully vaccinated and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.” *

Yes
No