This self-assessment must be completed by all visitors prior to entering our facilities. If you answer YES to any of the questions below, please do not visit.
Please enter this on your mobile device, or print the results, to present at your destination.
First Name: * Last Name: * Phone: * If you are completing this screening for any other individuals with you, please enter their first and last name(s) here, also update total number of people. Leave blank if you are screening only for yourself. Additional Names: Total Number in your party (Max 10 and subject to current public health rules):
First Name: *
Last Name: *
Phone: *
If you are completing this screening for any other individuals with you, please enter their first and last name(s) here, also update total number of people. Leave blank if you are screening only for yourself. Additional Names: Total Number in your party (Max 10 and subject to current public health rules):
City Hall Welland Community Wellness Complex Youth Arena Main Arena Library - Civic Square Library - Diamond Trail Library - Seaway Mall
* required fields
• * List of Symptoms
Yes No
I confirm that I have reviewed the questions above and the information being submitted is true and correct.
If you answered YES to any of these questions, do not visit our locations. Call your health care provider or the Niagara Region COVID-19 Info-Line at 905-688-8248. A public health professional will give you detailed instructions to follow to protect you, your family and other members of the public.