Have you received your second vaccine dose?
    yesno

    In the last 10 days, has someone you live with been sick with symptoms associated with COVID-19?
    yesno

    In the last 10 days, has someone you live with tested positive for COVID-19 on a PCR or rapid antigen test?
    yesno

    In the last 10 days, have you tested positive for COVID-19 on a PCR or rapid antigen test?
    yesno

    In the last 10 days, have you been identified as a "close contact" of someone who currently has COVID-19?
    yesno

    Have you been told you should be isolating?
    yesno

    In the last 10 days, have you travelled outside Canada?
    yesno

    Fever and/or chills
    yesno

    New cough or barking cough
    yesno

    Shortness of breath
    yesno

    Decrease or loss of sense of smell or taste
    yesno

    Muscle aches / joint pain
    yesno

    Extreme tiredness
    yesno

    Sore throat
    yesno

    Runny nose with unknown cause (e.g., being out in the cold)
    yesno

    New or unusual headache
    yesno

    Nausea, vomiting and/or diarrhea
    yesno