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MeadowWoods Celebration COVID-19 Screening Questionnaire
Everyone who is attending must complete this COVID-19 screening questionnaire on the day of the event (September 25, 2021). Passing this screening is mandatory to be allowed into the event. Thanks!

Please note: Fully vaccinated (as referred to in some questions below) is defined as an individual ≥14 days after receiving their second dose of a two-dose COVID-19 vaccine series or their first dose of a one-dose COVID-19 vaccine series.
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Your name *
Phone Number *
Date *
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DD
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YYYY
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions. *
Yes
No
Fever or chills
Difficulty breathing or shortness of breath
Coughing or barking, sore throat or difficulty swallowing
Decrease or loss of smell or taste
Pink eye
Runny or stuffy/congested nose
Digestive issues like nausea, vomiting, diarrhea, or stomach pain
Extreme fatigue, joint/muscle pains, or headaches that are unusual and long-lasting
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? *
In the last 14 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 (e.g., you are fully vaccinated or another reason), select “No.” *
In the last 14 days, have you received a COVID Alert exposure notification on your cellphone? - If you are fully vaccinated or have already gone for a test and got a negative result, select "No." *
In the last 14 days, have you or someone you live with travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements? - If you are fully vaccinated, select “No.” *
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.” *
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