ArtC customer screening
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