Your name (required) Name of the person you are meeting with Your email Meeting Date Location OttawaTorontoEdmontonCalgaryVancouverVictoria 1. Are you fully vaccinated against COVID-19 or have you tested positive for COVID-19 in the last 90 days and since been cleared? YesNo 2. Have you traveled outside of Canada in the last 14 days? YesNo Select the answer that reflects your travel: I have travelled internationally in the last 14 days and have received the necessary negative PCR test results backI have travelled internationally in the last 14 days and have not received my PCR results backI have travelled to the United States in the last 14 days 3. Have you been in close contact with someone who has tested positive for COVID-19 in the past 10 days? If you are fully vaccinated and have not been advised to self-isolate by your doctor, health care provider, or public health unit, answer "No". YesNo 4. In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? If you are fully vaccinated and/or already went for a test and got a negative result, answer “No” YesNo 5. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms (e.g. cough, fever, difficulty breathing, runny nose) YesNo 6. Has a doctor, health care provider, or public health unit told you (participant and/or spectator) that you should CURRENTLY be isolating or staying at home? (For example, if you've been told to isolate for a specific number of days (ex: 10 days) and that time has not yet lapsed (you are at day 8 of 10), then you would answer yes to this question)? YesNo 7. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? If you have since tested negative on a lab-based PCR test?YesNo 8. Do you have any of the following symptoms? Choose any/all that are new or worsening, and not related to other known causes or conditions you already have. Fever and/or chills (Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher)Cough or barking cough (croup) (Continuous, more than usual, making a whistling noise)Shortness of breath (Out of breath, unable to breathe deeply)Decrease or loss of taste or smellSore throat or difficulty swallowing (painful swallowing)Runny or stuffy/congested nosePink eye (Conjunctivitis)Digestive issues like nausea/vomiting, diarrhea, stomach painFalling down oftenNo Symptoms
