COVID-19 Self-Assessment

    Are you currently experiencing any of these symptoms?

    Choose any/all that are new, worsening, and not related to a medical condition you already have.

    In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?

    This includes getting a COVID Alert exposure notification.

    In the last 14 days, have you been in close physical contact with someone who either:
    • is currently sick with a new cough, fever, difficulty breathing, or other symptoms associated with COVID-19? or
    • returned from outside of Canada in the last 2 weeks?

    Close physical contact means any of the following while not wearing the appropriate personal protective equipment (PPE):

    • being less than 2 metres away in the same room, workspace, or area
    • living in the same home
    • being in the same classroom

    Have you travelled outside of Canada in the last 14 days?

    This does not include essential workers who cross the Canada-US border regularly.

    Please note: If after sending the form, you do not see a confirmation, please scroll up to see if you missed a required field. (It will be marked with a red "X".

    IMPORTANT:

    After you have pressed send, please make sure you see a green confirmation box below. If not, please check that you have filled in all required fields.