COVID COVID Screener Use this form for daily self screening and report any changes in health. This screener uses the EOHU template which can be found at https://eohu.ca/files/resources/12139-icd-20e.pdf?95f7fdc484Date* Date Format: MM slash DD slash YYYY Name First Last Email Have you travelled outside of Canada in the last 14 days* Yes No Has someone you are in close contact with tested positive for COVID-19 in the last 14 days?* Yes No Are you in close contact with a person who is sick with new respiratory symptoms or who recently traveled outside of Canada?* Yes No Do you have a fever?* Yes No (temperature ≥37.8°C)Tempurature ReadingDo you have any of these symptoms?* Chills New or worsening cough Barking cough (croup) Shortness of breath/difficulty breathing Sore throat Difficulty swallowing Loss of taste or smell Pink eye (conjunctivitis) Headachethat is unusual or long-lasting Runny or stuffy nose (not related to seasonal allergies or other known causes or conditions) Nausea/vomiting/diarrhea/abdominal pain Muscle aches Unexplained fatigue/malaise Falling more than usual None of the above Check all that applyIf you answered YES to any of the above you will not be granted access and you should wear a mask, immediately go home and self isolate. This iframe contains the logic required to handle Ajax powered Gravity Forms.
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