KawarthaNordic

While visiting Kawartha Nordic today, you will be (check all the apply)

In the last 10 days have you experienced any the following symptoms?

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 when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)

Shortness of breath

Out of breath, unable to breath deeply (not related to asthma or other known causes or conditions you already have)

Decrease or loss of taste or smell

Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

Select No, if

Fully vaccinated or under 12 years of age and not immune compromised and experienced the symptom(s) over 5 days ago and the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and no fever is present.

Select No, if

Unvaccinated or immune compromised and experienced the start of symptom(s) over 10 days ago and the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and no fever is present.

Select No, if

Symptomatic, but tested negative for COVID-19 on a single PCR test or two rapid antigen tests (RAT) taken 24-48 hours apart and symptoms have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and no fever is present.

In the last 10 days have you experienced any of the following symptoms?

Runny or stuffy/congested nose

Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have

Headache

New, unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)

Extreme tiredness

Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

Sore throat

Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)

Muscle aches/joint pain

Unusual, long-lasting (not related to a COVID-19 vaccine and/or flu shot in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)

Nausea, Vomiting, and/or Diarrhea

Not related to irritable bowel syndrome, anxiety, menstrual cramps, medication side effects, or other known causes or conditions you already have

Select No, if

Fully vaccinated or under the age of 12 years and not immune compromised and experienced the symptom(s) over 5 days ago, the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and no fever is present.

Select No, if

Unvaccinated or immune compromised and experienced the start of symptom(s) over 10 days ago, the symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and no fever is present.

Select No, if

Symptomatic, but tested negative for COVID-19 on a single PCR test or two rapid antigen tests (RAT) taken 24-48 hours apart and your symptom(s) have been improving for over 24 hours (48 hours for gastrointestinal symptoms) and no fever is present.

In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

In the last 10 days, have you tested positive for COVID-19 (on a lab-base PCR test, rapid antigen test, or home-based self-testing kit)?

Select No, if

Fully vaccinated or under 12 years of age and not immune compromised and the test was more than 5 days ago.

Do any of the following apply?

• You live with someone who is currently isolating because of a positive COVID-19 test
• You live with someone who is currently isolating because of COVID-19 symptoms
• You live with someone who is waiting for COVID-19 test results

Select No, if

you tested positive for COVID-19 (on a lab-based PCR test, rapid antigen test or home based self-testing kit) within the last 90 days and have already completed your isolation period.

In the last 10 days (5 days for those under 12 years of age), have you been identified as a “close contact” of someone who currently has COVID-19 and doesn't live with you?

Select No, if

Fully vaccinated and not immune compromised

Select No, if

you tested positive for COVID-19 (on a lab-based PCR test, rapid antigen test or home based self-testing kit) within the last 90 days and have already completed your isolation period.

Contact information is required for all visitors that join KN groups or use KN services.

This phone number or email address may be used by Kawartha Nordic and/or Peterborough Public Health for contact tracing, if a positive case is linked to Kawartha Nordic.

Personal information collected by this COVID-19 Screening Tool will be used only in relation to COVID-19 measures, and will only be shared as required by law.

By submitting this form, I declare that the information given here is true, correct, and complete. I am aware that I may be held liable for knowingly providing incorrect information.