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COVID-19 Pre-Screening Questionnaire For NFFRC Entrants

All entrants of the Nature Fresh Farms Recreation Centre are required to pre-screen themselves prior to each entry to our facility. If you feel ill, do not enter the facility. Upon completion of the questionnaire, please be prepared to show entry confirmation to our staff at the entrance door.

 

Please note: You will select your answers for questions 1 through 5 at the end of the questionnaire.

 

1. Do you or anyone else indicated on this form have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

Fever or chills (Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher)

Cough or barking cough (croup)

Shortness of breath, out of breath, unable to breathe deeply

Decrease or loss of smell or taste

Fatigue, and/or muscle aches/joint paint, unusual, long-lasting

Sore throat, painful or difficulty swallowing

Runny or stuffy/congested nose

New, unusual, long-lasting headache

Digestive issues like nausea, vomiting, and/or diarrhea

2. In the last 10 days, have you tested positive for COVID-19? (If you are fully vaccinated and not immune compromised and the test was more than 5 days ago, select “No”).

3. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *This can be because of an outbreak or contact tracing.

4. Is anyone you live with currently isolating because of any new COVID-19 symptoms and/or tested positive on a rapid antigen or PCR test, or waiting for COVID-19 test results? (If you tested positive and completed your isolation period select "No").

5. In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19 and doesn’t live with you? (If you are fully vaccinated and not immune compromised, select “No”).

6. In the last 14 days, have you or someone in your household travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?



Contact(s)

© 2020 The Municipality of Leamington 111 Erie Street North, Leamington, Ontario N8H 2Z9

Phone: 519-326-5761
Fax: 519-326-2481
Email: General Information

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