Please fill out this form prior to entering the facility. We cannot allow any individuals into the facility without the screening form completed with the necessary questions answered accordingly. Thank you for your cooperation and are looking forward to seeing you inside!
Screening Questions (answer YES or NO to all questions)
1. Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions.
Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have
Not related to asthma or other known causes or conditions you already have
Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have) If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”
If public health has advised you that you do not need to self-isolate (e.g., you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been cleared), select “No.”
If you have already gone for a test and got a negative result, select "No." If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
If you have since tested negative on a lab-based PCR test, select “No.”
If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”
If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”
Results of Screening Questions: • If the patron answered NO to all questions from 1 through 9, they can enter the business or organization. In the business or organization, the patron must continue to follow all public health measures, including masking, maintaining physical distance and hand hygiene, where applicable. • If the patron answered YES to any questions from 1 through 9, they should not be permitted to enter the business or organization (including any outdoor or partially outdoor business or facility). They should be advised to go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1-866-797- 0000) to get advice or an assessment, including if they need a COVID-19 test. • If the patron answered YES to question 9, they must be advised to stay home, along with the rest of the household, until the sick individual gets a negative COVID-19 test result, is cleared by their local public health unit, or is diagnosed with another illness. 6 | Page • If any of the answers to these screening questions change during the day, this screening result is no longer valid and the patron may need to screen again, wherever necessary. • Any record created as part of patron screening may only be disclosed as required by law.
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20 Scarsdale Road, Building B, Elite Training Centre (ETC), Toronto, ON, M3B 2R2, CA 905-326-9214
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