COVID-19 Pre-Screening
COVID-19 Pre-Screening for Done Salon Appointments
We require that you fill out every question below and submit this pre-screening before you come for your appointment.
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Email *
Please enter your full name: *
Please enter your phone number: *
What date is your appointment? *
MM
/
DD
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YYYY
What time is your appointment? *
Time
:
3. Do you or the person you are inquiring about have any of the following symptoms: severe difficulty breathing (e.g., struggling for each breath, speaking in single words), chest pain, confusion, extreme drowsiness or loss of consciousness? *
4. Do you or the person you are inquiring about have shortness of breath at rest or difficulty breathing when lying down? *
5. Do you have a new onset of any of the following symptoms: fever/chills, cough, sore throat/hoarse voice, shortness of breath, loss of taste or smell, vomiting, or diarrhea for more than 24 hours and if the patient is an infant, poor feeding and lethargy? *
6. Do you have a new onset of 2 or more of any of the following symptoms: runny nose, muscle aches, fatigue, conjunctivitis (pink eye), headache, skin rash of unknown cause or nausea or loss of appetite? *
7. Have you been in contact in the last 14 days with someone that is confirmed to have COVID-19? *
8. Have you had laboratory exposure while working directly with specimens known to contain COVID-19? *
9. Have you been in a setting in the last 14 days that has been identified by public health as a risk for acquiring COVID-19, such as on a flight, in a workplace with a cluster of cases, or at an event? *
10. Have you traveled outside of Manitoba in the last 14 days, excluding personal travel to border communities?(Note that workers who routinely travel inter-provincially for work and those involved in commercial transportation of goods and services are excluded) *
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