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COVID-19 Visitor Self Assessment

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.

 

   

   

   

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.
   
   

What location are you visiting today? *
 
 
 
 
 
 
 

* required fields

 

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.
Fever/chills
           
Difficulty breathing or shortness of breath
           
Cough
           
Sore throat. Trouble swallowing
           
Runny nose/Stuffy nose or nasal congestion
           
Decrease or loss of smell or taste
           
Nausea, vomiting, diarrhea, abdominal pain
           
Not feeling well, extreme tiredness, sore muscles
           
2. Have you travelled outside of Canada in the past 14 days?
           
3. Have you had close contact with a confirmed or probable case of COVID-19?
           

   

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.