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