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For Volunteers: COVID-19 Self-Assessment Form
All Big Brothers Big Sisters volunteers in a 1:1 match are required to complete this form prior to an in-person match meeting
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Today's Date *
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Your First & Last Name *
Your Little Brother/Sister's First & Last Name *
Your Caseworker's First Name: *
Are you currently experiencing any of the following symptoms that may be associated with COVID-19: fever, shortness of breath, cough that's new/worsening, sore throat, unusual fatigue, runny nose/stuffy nose or nasal congestion, nausea, vomiting, diarrhea, abdominal pain or not feeling well? *
In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID-19? *
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
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In the last 14 days, have you travelled outside of Canada? If you are exempt from federal quarantine requirements (for example, you are fully vaccinated and have met the specific conditions), select “No.” *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
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Considering your answers above, and the health and safety of both you and your Little Brother/Sister, are you comfortable meeting with them for an in-person visit? *
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