Trace and Track Form

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Christmas Eve - 4:00 pm. Service

Surname, First Name *

Telephone Number *

Email Address *

Address

Guest - Guest - Surname, first name, email, telephone number

Do you or any of your guests have any of the following COVID-19 symptoms: Fever and/or chills; Cough or barking cough (croup); Shortness of breath; Decrease or loss of smell or taste; Sore throat or difficulty swallowing; Runny or stuffy/congested nose; Headache; Nausea, vomiting and/or diarrhea; Extreme tiredness or muscle aches? *

Yes

Has a doctor, health care provider, or public health unit told you or your guests that you should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. *

Yes

In the last 10 days, have you tested positive on a rapid antigen test or a home- based self-testing kit? If you have since tested negative on a lab-based PCR test, select “No". *

Yes

In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? If you are fully vaccinated* and have not been advised to self-isolate by public health, select “No”. *

Yes

In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you are fully vaccinated and/or have already gone for a test and got a negative result, select "No." *

Yes

In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements? *

Yes

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.” *

Yes

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