COVID Self Assessment

Arctic Response COVID Self Assessment

Name
Do you have any of the following symptoms, which are worsened if associated with allergies, chronic or pre-existing conditions: 


  • fever

  • cough

  • shortness of breath

  • difficulty breathing

  • sore throat¬†

  • runny nose

In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, have you come in close contact with a personal who has a probable or confirmed case of COVID-19?
In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, have you come in close contact with a person who had an acute respiratory illness that started withing 14 days of their close contact to someone with a probable or confirmed case of COVID-19?
In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, have you come in close contact with someone who had an acute respiratory illness who returned from travel outside of Canada in the 14 days before they became sick?
In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, did you have a laboratory exposure to biological material (i.e. primary clinical specimens, virus culture isolates) know to contain COVID-19?

By submitting this assessment, you certify that all information is correct to the best of your knowledge.