Pre-Assement Consent Form
    To be completed prior to event
    First Name
    Last Name
    Phone Number
    Covid-19 Questions :
    1. Do you have one or more of the COVID-19 symptoms below?
    If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”
    YesNo
    2. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
    This can be because of an outbreak or contact tracing
    YesNo
    3. In the last ten days, have you tested positive on a rapid antigen test or a homebased self-testing kit?
    If you have since tested negative on a lab-based PCR test, select “No.
    YesNo
    4. Have you been identified as a “close contact” of someone who currently has COVID-19 in the last 14 days?
    If you are fully vaccinated and have not been advised to self-isolate by public health, select “No”.
    YesNo
    5. Have you received a COVID Alert exposure notification on your cell phone in the last 14 days (and have not been tested or waiting for your result)?
    If you are fully vaccinated and/or have already gone for a test and got a negative result, select "No."

    YesNo
    6. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?
    If you are not fully vaccinated and you live with someone who travelled outside of Canada, see Notes1 below.
    YesNo
    7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If you are fully vaccinated, select “No.”
    If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”
    YesNo
    If you answer YES to any one of the questions above, PLEASE DO NOT enter this location AND contact either your health care provider or Telehealth Ontario(1-866-797-0000) to get advice or an assessment, including if you need a COVID-19 test.
    Note:
    1. Effective July 5, 2021, fully vaccinated Canadians may be exempt from post-travel COVID-19 quarantine restrictions. For those individuals who are not fully vaccinated AND either 1) live with an individual who has recently traveled outside of Canada OR 2) live with an individual who is self-isolating due to a high-risk exposure: These individuals are permitted to attend work but they are required to stay home except for essential reasons for the duration of the contact’s isolation period. Essential reasons include: attending school/child care/work and essential errands such as, obtaining groceries, attending medical appointments or picking up prescriptions.

    SHARE
    Previous articleCovid-19
    Next articlecovid-19