COVID-19 Symptom-based Screening Questionnaire for non-Dawson individuals ImportantThis form is required for accessing the building starting Monday, August 31st, and must be filled within 24 hour prior to coming to the College.Person IdentificationPerson TypeEG: Parent, Occasional Staff, etc.Name* First Last Phone Number*(Your 10-digit phone number will be used as your identification number when entering the Dawson campus)Phone Number UnformattedEmail AddressPerson Type*CoachAthletic therapistContractorCTD studentHaving one or more of the following symptoms justifies access to college being denied or immediate removal from the CollegeDo you feel feverish, have flu-like chills, or a fever with an oral temperature of 38°C (100.4°F) or higher?*YesNoDo you have a new cough or has your cough gotten worse recently?*YesNoAre you experiencing unusual trouble breathing or shortness of breath?*YesNoHave you had a sudden loss of smell and/or taste?*YesNoHave you been diagnosed with COVID-19 within the last 14 days?*YesNoAre you awaiting results of a lab test for COVID-19?*YesNoAre you currently under a Public Health Authority instructions to self-isolate?*YesNoHave you been in close and prolonged contact with someone who has been diagnosed with COVID-19 (same household or apartment)?*YesNoDid you return from travel outside Canada within the last 14 days?*YesNoAn affirmative answer to two of the following three questions or more justifies access to college being denied or immediate removal from the CollegeDo you have one or more of the following general symptoms?*Unusually intense fatigue for no obvious reasonUnusual headacheLoss of appetiteUnusual or unexplained muscle painYesNoHave you had nausea, vomiting, or diarrhea in the past 12 hours?*YesNoDo you have a sore throat with no obvious cause?*YesNoAffirmative answer to two of the preceding three questionsConditions of EntryBy submitting this form, I confirm these questions have been answered honestly and I hereby agree to comply with the procedures implemented by the College to prevent and control infection and to ensure everyone’s health and safety. You have answered Yes to one or more questions.Please click Submit to continue your submission or Back to review your answers.