COVID-19 Symptom-based Screening Questionnaire for non-Dawson individuals ImportantFilling this form is required for accessing the College starting Monday, August 31st, and should be done within 24 hours prior coming to the College, preferably before leaving home. Failing to disclose symptoms, risk factors, or providing false declaration in the course of this assessment is considered a breach of the Dawson College Code of Conduct and may be liable to sanctions by Dawson college authorities.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?*YesNoHave you had a sudden loss of smell and/or taste?*YesNoDo you have a new cough or, in the case of people suffering from chronic cough, has your usual cough gotten worse recently?*YesNoAre you experiencing new or unusual breathing difficulties or shortness of breath? In the case of people suffering from chronic respiratory conditions (ex. asthmatics), did you notice a sudden increase in frequency or severity of symptoms?*YesNoDo you have a new or unusual sore throat, without obvious reasons?*YesNoDo you have a runny nose, without obvious reasons?*YesNoAre you currently awaiting results of a lab test for COVID-19?*YesNoWithin the last 14 days, have you been diagnosed with COVID-19*YesNoWithin the last 14 days, have you been personally instructed to self-isolate by a health care professional or by Public Health Authority?*YesNoWithin the last 14 days, have you been in close and prolonged contact with someone who has been diagnosed with COVID-19 (Excluding health care workers wearing proper Personal Protection Equipment (PPE) at work)?*YesNoWithin the last 14 days, did you return from travel outside Canada?*YesNoHaving at least two (2) of the following symptoms justifies access to College being denied or immediate removal from the building:Do you have unusual abdominal/stomach pain?*YesNoHave you had nausea or vomiting in the past 12 hours?*YesNoHave you had diarrhea in the past 12 hours?*YesNoAre you experiencing unusually intense fatigue for no obvious reason?*YesNoAre you experiencing a significant loss of appetite?*YesNoAre you having unusual or unexplained muscle pain, or stiffness (not related to physical activity)?*YesNoHave you been experiencing unusual headache?*YesNoAffirmative answer to minimum two (2) of the six (7) the preceding symptomsConditions of Entry ATTENTION! Before submitting this form, please review all your answers and make sure you did not press the wrong answer by mistake. By 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. Please note that any questionnaire with an affirmative answer (a “yes”) will be forwarded in strictest confidence to the College Nurses of Dawson’s Health Services and to the Director of Human Resources (employees only). You have answered Yes to one or more questions.Please click Submit to continue your submission or Back to review your answers.