Covid-19 Screening Form

Your Information




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
  • This screening must be completed within 24 hours prior to attending a program
  • 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?

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

2. In the last 14 days, have you had close physical contact with someone who either:

  1. Is currently sick with new COVID-19 symptoms (like a cough, fever, or difficulty breathing)?
  2. Returned from outside of Canada in the last 2 weeks with new COVID-19 symptoms (like a cough, fever, or difficulty breathing)?

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

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

4. Do you have any of the following symptoms?

  • Fever
  • New onset of cough
  • Worsening chronic cough
  • Shortness of breath
  • Difficulty breathing
  • Sore throat
  • Difficulty swallowing
  • Decrease or loss of sense of taste or smell
  • Chills
  • Headaches
  • Unexplained fatigue/malaise/muscle aches (myalgias)
  • Nausea/vomiting, diarrhea, abdominal pain
  • Pink eye (conjunctivitis)
  • Runny nose/nasal congestion without other known cause
  • If you’re over 70:
    • Delirium
    • unexplained or increased number of falls
    • acute functional decline
    • worsening of chronic conditions

If you answered NO to all of the above questions, you may attend the program as scheduled.


If you answer YES to any of the above questions, you may not attend the program and should contact the Simcoe Muskoka District Health Unit for information on what you should do next.