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Artc customer screening

Do you or any of your family members have any of the following symptoms?

    New or worsening cough

    Yes                                 No

    Shortness of breath

    Yes                                 No

    Sore throat 

    Yes                                 No

    Runny nose, sneezing or nasal congestion 

    Yes                                 No

    Hoarse voice 

    Yes                                 No

    Difficulty swallowing 

    Yes                                 No

    New smell or taste disorder(s) 

    Yes                                 No

    Nausea/vomiting, diarrhea, abdominal pain 

    Yes                                 No

    Unexpected fatigue/malaise 

    Yes                                 No

    Headache 

    Yes                                 No


    Have you or any of your family members traveled outside of Canada and/or had close contact with anyone that has travelled outside of Canada in the past 14 days?

      Yes                                 No

      Do you or any of your family members have a fever?

        Yes                                 No

        Have you or any of your household had close contact with anyone with respiratory illness or a confirmed/probable case of COVID-19?

          Yes                                 No

          If you answered Yes to the previous question When you had close contact with a suspected or confirmed case of COVID-19, did you wear the required and/or recommended PPE according to the type of contact (e.g. goggles, gloves, mask, gown, or N95?

          Yes                                 No

           
           
           

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