Self-Screening for Signs of illness or Communicable Diseases 2021
Please inform MPCC staff if you have any of the symptoms for infection prevention control procedures
Full Name (i.e.First name and Last Name)姓氏及名字 *
Contact Phone No. *
Do you have any of the following symptoms:您是否有以下任何症狀 *
Yes
No
Fever 發熱
chills 發冷
Pink eye 紅眼病
Sore Throat cough/New onset of cough 喉嚨痛咳嗽/新的咳嗽發作
Shortness of breath/Difficulty breathing 呼吸急促/呼吸困難
Runny or Congested nose 流鼻涕 或 鼻塞
Difficulty swallowing 吞嚥困難
Digestive issues (Nausea/Diarrhea/Vomiting/Stomach Pain) 消化不良(噁心/腹瀉/嘔吐/胃痛)
Decrease or loss of sense of taste or smell 減少或喪失味覺或嗅覺
Joint pain /muscle aches/Headache 關節痛/肌肉酸痛/頭痛
Extreme tiredness 極度疲勞
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? 是否有醫生,衛生保健提供者或公共衛生部門告訴您您應該目前正在隔離(在家中)? *
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? 在過去的14天中,您是否收到了關於COVID警報通知在您的手機? *
Do you have close contact with anyone with acute respiratory illness or travelled outside of Ontario and Canada 您是否與任何患有急性呼吸系統疾病的人有過密切接觸或曾在安大略省和加拿大境外旅行過 *
Hand sanitization when you arrive MPCC 到達時有否消毒雙手 *
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