Covid-19 Health Declaration

How are you feeling today?

In the past 14 days, at work or elsewhere, did you have close contact with someone who has a probable or confirmed case of COVID19?
Do you have any of the following symptoms which are new or worsened if associated with allergies, chronic or pre-existing conditions: fever, cough, shortness of breath, difficulty breathing, sore throat, and/or runny nose?
Have you returned from outside the country (including Canada / USA) in the past 14 days?
In the past 14 days have you been directed by Public Health to self-isolate?