COVID-19 Self Screening Questionnaire

You must answer “NO” to all the questions in this questionnaire in order to enter our physical location. If you answer “YES” to any of the questions, please DO NOT come or enter the venue.

If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND notify us.

If you answered “Yes” to question one, please DO NOT come. You should:

• Self- quarantine for at least 10 days from the date on which you first experienced any of the above symptoms ; AND
• Wait until you have had no fever for at least 3 days (without the use of fever-reducing medication) AND
• Improved respiratory symptoms (no cough, shortness of breath)

If you answered “Yes” to any part of question two, please DO NOT come. You should self quarantine for at least 14 days.

I certify to the best of my knowledge; this information is accurate.

*Information shared will be kept confidential.