I have had close contact with someone with acute respiratory illness in the past 14 days
    yesno

    I have a confirmed case of COVID-19 or have had close contact with a person with a confirmed case of COVID-19 without wearing the appropriate personal protective equipment (PPE)
    yesno

    I have traveled outside of CANADA in the past 14 days
    yesno

    Fever
    yesno

    Chills
    yesno

    Cough that's new or worsening (continuous, more than usual)
    yesno

    Barking cough, making a whistling noise when breathing
    yesno

    Shortness of breath (out of breath, unable to breath deeply)
    yesno

    Sore throat
    yesno

    Difficulty swallowing
    yesno

    Runny, stuff, congested nose (not related to seasonal allergies or other known causes or conditions)
    yesno

    Lost sense of taste or smell
    yesno

    Pink eye (conjunctivitis)
    yesno

    Headache that's unusual or long lasting
    yesno

    Digestive issues (nausea/vomiting, diarrhea, stomach pain)
    yesno

    Muscle aches
    yesno

    Extreme tiredness that's unusual (fatigue, lack of energy)
    yesno

    Falling down often
    yesno

    For young children and infants: sluggishness or lack of appetite
    yesnoN/A

    Delirium
    yesnoN/A

    Unexplained or increased number of falls
    yesnoN/A

    Acute functional decline
    yesnoN/A

    Worsening or chronic symptoms
    yesnoN/A