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Daily Pre-Entry COVID-19 Screening

Please complete this screening prior to arriving at the facility. 

If you cannot complete this screening assessment prior to your arrival at the facility, you must complete it immediately upon arrival and refrain from contact with anyone and common spaces until the screening is completed.


Symptom List

  • Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
  • Cough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
  • Shortness of breath - Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
  • Decrease or loss of smell or taste - Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
  • (For adults 18 years or older) Muscle aches/joint pain - Unusual, long-lasting (not related to getting a COVID-19 vaccine in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
  • (For adults 18 years or older) Extreme tiredness - Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
  • (For children < 18 years) Nausea, vomiting and/or diarrhea - Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have

 


Screening Questions

  1. In the last 10 days, have you been identified as a "close contact" of someone who currently has COVID-19? If public health has advised you that you do not need to self-isolate (if you are fully immunized or have tested positive for COVID-19 in the last 90 days and have since been cleared), select "No".
  2. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per federal quarantine requirements)?
  3. In the past 10 days, at work or elsewhere, did you have close contact with someone who has a probable or confirmed case of COVID-19? If public health has advised you that you do not need to self-isolate (if you are fully immunized or have tested positive for COVID-19 in the last 90 days and have since been cleared), select "No".
  4. 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.
  5. In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? If you already went for a test and get a negative result, select "No". If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since have been cleared, select "No". 
  6. 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 immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No.". If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only begun after vaccination, select "No"
  7. In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? If you have since tested negative on a lab-based PCR test, select "No."
  8. In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)? If you are fully immunized, or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
  9. In the last 10 days, has someone in your household (someone you live with) been identified as a "close contact" of someone who currently has COVID-19 AND advised by a doctor, health care provider or public health unit to self-isolate in the last 10 days? If you are fully immunized, or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."

 

 

The Municipality of South Huron is committed to protecting the private information of our clients. The information entered on this form is collected under authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). This information will only be used for screening to keep our staff and visitors safe from the transmission of COVID-19.



Contact(s)

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We work hard to ensure that everyone can access the information and services they need.

For information in alternative formats or assistance accessing information, please contact the Municipal Office at 519-235-0310. 

© 2020 The Municipality of South Huron, 322 Main Street South P.O. Box 759 Exeter, ON N0M 1S6