Please include the names of everyone from the same household that is in attendance to the time and location listed below.
Please list the full names of all those attending seperated by a comma
Check All That Apply
Example: ###-###-####
A copy of your submission will be sent to this email address.
COMPLETE THIS SECTION WITH REGARDS TO THE ICE TIME YOU WILL BE ATTENDING
These questions have been defined by the Ministry of Health and must be completed prior to entering the facility. This screening tool in not intended to take the place medical advice, diagnosis, treatment or legal advice.
This can be because of an outbreak or contact tracing.
If public health has advised you that you do not need to self-isolate (e.g. you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been celared), select "NO".
If you have since tested negative on a lab-based PCR test, select "NO".
If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select "NO". If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select "NO".