Name

First Name

Last Name

Date

YYYY

Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

Fever or chills

Difficulty breathing or shortness of breath

Cough or Barking cough

Decrease or loss of smell or taste

Extreme tiredness

Muscle Aches/ Joint pain

Have you travelled outside of Canada in the past 14 days?

If exempt from federal quarantine requirement (for example, fully vaccinated) select "NO"

In the last 10 days, have you been identified and a "close contact" of someone who currently has COVID-19?

If public health has advised you that you do not have to self-isolate, select "NO"

If the answer is “YES” to any of the following questions, access to Colonial Tool will be denied.

I UNDERSTAND