TAOC COVID-19 Screening

Name* Phone Number* Email* Within the last 14 days, have you had close contact (within 6 feet) or cared for someone diagnosed with COVID-19 or with someone waiting on COVID-19 test results?* Yes No Within the last 14 days have you had or experienced flu like symptoms (cough, sore throat, cold fever, upset stomach, respiratory illness and/or had difficulty breathing)?* Yes No Have you been quarantined in the past 14 days?* Yes No Have you traveled outside or arrived in Canada within the last 14 days? Travel for essential work only answer no.* Yes No