Normal oral temperature averages between 97° F (36.1° C) and 99° F (37.2° C). A fever is considered to be 100.4° F (38° C) or more. Any person who has a fever or a persistent cough shall be put in self-isolation until their temperature drops into the normal range and stays there for at least 10 days.

Are you exhibiting any of the following symptoms?

Muscle Aches/Fatigue

Yes No

Runny Nose

Yes No

Chills

Yes No

Sore Throat

Yes No

Headache

Yes No

Nausea and Vomiting

Yes No

Diarrhea

Yes No

Loss of Sense of Smell/Taste

Yes No

Loss of Appetite

Yes No

During the last 14 days have you travelled outside Canada?

Yes No

Have you been in personal contact with anyone confirmed to be infected with COVID-19?

Yes No

Have you been in personal contact with anyone who has been in self-isolation?

Yes No

Name: John Mohammed Dave Martin Darren Franko Makenzie Leine

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