JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Apple Salon Screening Questions
This provides basic information only and contains recommendations for businesses or organizations for COVID-19 screening as per Ontario Regulation 364/20.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What is your Full Name? (First Name / Last Name)
*
Your answer
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 or Chills
Difficulty breathing or shortness of breath
Cough
Sore throat, trouble swallowing
Runny nose / Stuffy nose or nasal congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
None
Required
Have you travelled outside of Canada in the past 14 days?
*
Yes
No
Have you had close contact with a confirmed or probably case of COVID-19
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
