For individuals 18 years of age or older
1. 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.
Choose any/all that are new, worsening, and not related to other known causes or medical conditions.
Fever and/or Chills
Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or
Yes No
Cough or barking cough (croup)
Continuous, more than usual, making a whistling noise when breathing, not related to other known causes or conditions (for example, asthma, post-infectious reactive airways, COPD)
Yes No
Shortness of Breath
Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma)
Yes No
Decrease or loss of smell or taste
Not related to other known causes or conditions (for example, allergies, neurological disorders)
Yes No
Sore Throat
Not related to other known causes or conditions (for example, seasonal allergies, acid reflux)
Yes No
Difficulty Swallowing
Painful swallowing, not related to other known causes or
Yes No
Pink eye
Conjunctivitis, not related to other known causes or conditions
Yes No
Runny or stuffy/congested nose
Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather)
Yes No
Headache that's unusual or long lasting
Not related to other known causes or conditions (for example,
Yes No
Digestive issues like nausea/vomiting, diarrhea, stomach pain
Not related to other known causes or conditions (for example, irritable bowel syndrome, menstrual cramps)
Yes No
Muscle aches that are unusual or long lasting
Not related to other known causes or conditions (for example, a sudden injury, fibromyalgia)
Yes No
Extreme tiredness that is unusual
Fatigue, lack of energy, not related to other known causes or conditions (for example, depression, insomnia, thyroid dysfunction)
Yes No
Falling down often
For older people
Yes No
For individuals under the age of 18
1. 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.
Choose any/all that are new, worsening, and not related to other known causes or medical conditions.
Fever and/or Chills
Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or
Yes No
Cough or barking cough (croup)
Continuous, more than usual, making a whistling noise when breathing, not related to other known causes or conditions (for example, asthma, post-infectious reactive airways, COPD)
Yes No
Shortness of Breath
Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma)
Yes No
Decrease or loss of smell or taste
Not related to other known causes or conditions (for example, allergies, neurological disorders)
Yes No
Sore throat or difficulty swallowing
Painful swallowing, not related to other known causes or
Yes No
Runny or stuffy/congested nose
Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather)
Yes No
Headache that's unusual or long lasting
Not related to other known causes or conditions (for example,
Yes No
Nausea, vomiting and/or diarrhea
Not related to other known causes or conditions (for example, irritable bowel syndrome, menstrual cramps)
Yes No
Extreme tiredness that is unusual Muscle aches
Fatigue, lack of energy, poor feeding in infants, not related to other known causes or conditions (for example, depression, insomnia, thyroid dysfunction, sudden injury)
Yes No
If you are an essential worker who crosses the Canada-US border regularly for work,
