RDN: 18 and Over Covid-19 Checklist
* Required
Participant's Name
*
Your answer
Contact Phone Number
*
Your answer
Contact Email
*
Your answer
Does the person attending the activity have any of the following symptoms?
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Fever
Cough - new or changed
Shortness of breath/Difficulty Breathing - new or changed
Sore throat
Chills
Painfull Swallowing
Runny nose/Nasal congestion - new or changed
Feeling unwell/Fatigued
Nausea/Vomiting/Diarrhea
Unexplained loss of appetite
Loss of sense of taste or smell
Muscle/joint aches - unexplained and unrelated to physical activity
Headache
Conjunctivitis
None of the above
Has the attendee travelled outside of Canada in the last 14 days? (Individuals are legally required to quarantine for 14 days when entering or returning to Alberta from outside Canada unless exempted by the Alberta COVID-19 Border Testing Pilot Program)
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Yes
No
Has the attendee had close contact1 with a confirmed case of COVID-19 in the last 14 days?
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Yes
No
If you answer yes to any of the questions above, please stay home and use the AHS online assessment tool to determine if testing for Covid-19 in necessary. This form will be kept on file for a minimum of two weeks.
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