AGL COVID-19 Visitor Screening
Required Screening Questions
Today's Date *
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First Name *
Last Name *
Phone number *
Company name (write N/A if not applicable) *
Purpose of visit *
Location *
Required
Your AGL contact's first name *
1. 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.
Fever and/or chills *
Cough or barking cough (croup) *
Shortness of breath *
Decrease or loss of smell or taste *
Sore throat *
Difficulty swallowing *
Pink eye *
Runny or stuffy/congested nose *
Headache that’s unusual or long lasting *
Digestive issues like nausea/vomiting, diarrhea, stomach pain *
Muscle aches that are unusual or long lasting *
Extreme tiredness that is unusual *
Falling down often *
2. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
3. In the last 14 days, have you or anyone you live with travelled outside of Canada? *
4. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? *
5. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
6. In the last 14 days, have you received a COVID Alert exposure notification on your cell? If you already went for a test and got a negative result, select “No.” *
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