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Ancaster Agricultural Society COVID Screening Form

* required field

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  1. Do you have any of the following new or worsening symptions or signs? Symptions should not be chronic or related to other known causes or conditions.* You must select one.

    Fever or chills
    Difficulty breathing or shortness of breath
    Cough
    Sore throat, trouble swallowing
    Runny nose/stuffy nose or nasal congestion
    Decrease or loss of smell or taste
    Nausea, vomiting, diarrhea, abdominal pain
    Not feeling well, extreme tiredness, sore muscles
    None of the above
  2. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
    Yes No

  3. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?*
    Yes No

  4. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?*
    Yes No

  5. Have you or anyone you lived with travelled outside of Canada in the past 14 days?*
    Yes No

  6. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
    Yes No


If you have any of the symptoms or answered YES to any of the above questions, you have not passed. Do not attend the Ancaster Fairgrounds. You should go home to self-isolate immediately and contact your health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test.