COVID - Assessment Lake Country Arthouse

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This is the daily health check that is required for anyone using the ArtHouse site, space & studios. This should be completed each day you are onsite. If you answer YES to any of the questions you cannot enter the ArtHouse building/site. Please also notify arthouse@lakecountryartgallery.ca . Each individual in attendance MUST complete this form.

Name (First Name, Last Name) of Attendee *

Name (First Name, Last Name) of parent/caregiver - if applicable

Email *

Daily Check Questions

Please answer all of these questions. If you answer YES to any of the questions you cannot enter the ArtHouse building/site. Please also notify arthouse@lakecountryartgallery.ca

Are you experiencing any of the following new or worsening symptoms? Fever, chills, cough, sore throat, difficulty breathing, diarrhea, nausea, vomiting, extreme fatigue/tiredness, body aches, loss of appetite, headache, loss of smell or taste *

Yes

Have you travelled outside of Canada, including the US, within the last 14 days? *

Yes

Have you been identified as a close contact of a COVID-positive case by Public Health? *

Yes

Have you been told to self-isolate by Public Health? *

Yes

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