Oshki COVID-19 Self Assessment
To be completed by everyone before entering the office.
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Email address
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Your email
Please enter your name
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Your answer
Are you currently experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or medical conditions.
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Fever - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing, not related to other known causes or conditions (for example, asthma, postinfectious reactive airways)
Shortness of breath - Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma)
Decrease or loss of smell or taste - Not related to other known causes or conditions (for example, allergies, neurological disorders)
None of the above
Required
If you answered “YES” to any of these symptoms:
Contact Administration to let them know about this result.
You should isolate (stay home) and not leave except to get tested or for a medical emergency.
Talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test.
Are you currently experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or medical conditions.
*
Sore throat or difficulty swallowing - Painful swallowing, not related to other known causes or conditions (for example, seasonal allergies, acid reflux)
Runny or stuffy/congested nose - Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather)
Headache that’s unusual or long lasting - Not related to other known causes or conditions (for example, tension-type headaches, chronic migraines)
Nausea, vomiting and/or diarrhea - Not related to other known causes or conditions (for example, irritable bowel syndrome, anxiety in children, menstrual cramps)
Extreme tiredness that is unusual or muscle aches - Fatigue, lack of energy, poor feeding in infants, not related to other known causes or conditions (for example, depression, insomnia, thyroid disfunction, sudden injury)
Pink eye. Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)
Falling down often. For older people.
None of the above
Required
If you answered “YES” to only one of these symptoms:
Contact Administration to let them know about this result.
You should isolate (stay home) for 24 hours and not leave except for a medical emergency.
After 24 hours if your symptom is improving, you can return to work when you feel well enough to go. You do not need to get tested.
If you answered “YES” to two or more of these symptoms:
Contact Administration to let them know about this result.
You should isolate (stay home) and not leave except to get tested or for a medical emergency.
Talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test.
If the answer is "Yes" to any of the following, check the corresponding box.
*
Have they travelled outside of Canada in the last 14 days?
In the last 14 days, has a public health unit identified them as a close contact of someone who currently has COVID-19?
Has a doctor, health care provider, or public health unit told them/you that they should currently be isolating (staying at home)?
In the last 14 days, have they received a COVID Alert exposure notification on their cell phone?
None of the above
Required
If you answered “YES” to two or more of these symptoms:
Contact Administration to let them know about this result.
You should isolate (stay home) for 14 days and not leave except to get tested or for a medical emergency.
Talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test.
If you answered “None of the above” to all questions, you may enter the office.
Masks must be worn at all times, over both your mouth and nose.
Send me a copy of my responses.
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