Your Information

First Name:


Last Name:


Email:


Phone Number

Introduction:

• Everyone planning to attend an in-person program at an Innisfil ideaLAB & Library location is required to complete the pre-screening for COVID-19
• Screening must be completed daily, before attending a program or an ideaLAB & Library branch.
• This screening tool is based on the Ministry of Health’s COVID-19 Patient Screening Guidance Document, V. 4.0 - June 11, 2020.
• This information will be maintained in accordance with the Library’s Confidentiality and Protection of Privacy Policy, and will only be provided to the Simcoe Muskoka District Health Unit when necessary for contact tracing purposes related to the COVID-19 pandemic

Screening Questions

1. In the last 14 days, have you had close physical contact with someone who tested positive for COVID-19? This includes receiving a COVID Alert exposure notification.

Close physical contact means a) being less than 2 metres away in the same room, workspace, or area b) living in the same home.

YesNo

2. Have you travelled outside of Canada in the last 14 days?

YesNo

3. Do you have any of the following symptoms? Select symptoms that are new, worsening and not related to other known causes or conditions.

FeverNew onset of coughWorsening chronic coughShortness of breathDifficulty breathingSore throatDifficulty swallowingDecrease or loss of sense of taste or smellChillsHeadachesUnexplained fatigue/malaise/muscle aches (myalgias)Nausea/vomiting, diarrhea, abdominal painPink eye (conjunctivitis)Runny nose/nasal congestion without other known causeFeeling confused or unsure where you areFalling down often