BC COVID-19 Symptom Self-Assessment Tool

Name*

First NameLast Name

Birthdate

Date

Temperature

Phone Number

Email

example@example.com

Do you have ANY medical reason why you can NOT wear a mask?*

YesNo

Location Coordinates

BC COVID-19 Symptom Self-Assessment Tool

This self-assessment tool, adapted from the BC Ministry of Health, will help determine whether you may need further assessment or testing for COVID-19. You can complete this assessment for yourself, or on behalf of someone else, if they are unable to.

Who should be tested for COVID-19?

People with respiratory symptoms who are:

Hospitalized, or likely to be hospitalized
Health Care Workers
Residents of long term care facilities
Part of an investigation of a cluster or outbreak

Who does not need to be tested for COVID-19?

People without symptoms.
Patients with mild respiratory symptoms who can be managed at home, including returning travellers with an onset of illness within 14 days of return to Canada.

The BC Ministry of Health strongly urges anyone who has symptoms - including a fever, cough, sneezing, sore throat, or difficulty breathing - to self-isolate for 14 days. To protect yourself while out in public, wash your hands frequently and maintain a distance of about 2 metres from others. For more information on COVID-19, refer to HealthLink BC's COVID-19 website.

The province has created a phone service to provide non-medical information about COVID-19, including the latest information on travel recommendations and social distancing. Information is available in more than 110 languages, 7:30 am - 8 pm at 1-888-COVID19 (1-888-268-4319) or via text message at 604-630-0300.

Are you experiencing any of the symptoms below?*

YesNo

Severe difficulty breathing (e.g. struggling to breathe or speaking in single words)
Severe chest pain
Having a very hard time waking up
Feeling confused
Losing consciousness

Please call 911 or go directly to your nearest emergency department.

These symptoms require immediate attention. You should call 911 immediately, or go directly to your nearest emergency department.

Are you experiencing any of the symptoms below?*

YesNo

Shortness of breath at rest
Inability to lie down because of difficulty breathing
Chronic health conditions that you are having difficulty managing because of difficulty breathing

Please call 811 to speak with HealthLink BC.

A nurse at HealthLink BC will need to speak to you about your symptoms in more detail. They are experiencing heavy call volumes and will get to your call as quickly as they can.

Are you experiencing any of the symptoms below?*

YesNo

Fever
Cough
Sneezing
Sore throat
Difficulty breathing

Please stay at home.

As a precaution, the Ministry of Health is asking anyone with symptoms (fever, cough, sneezing, sore throat, or difficulty breathing) to stay home for 14 days. Continue with this tool to determine additional precautions/steps you should take.

Have you travelled to any countries outside Canada (including the United States) within the last 14 days?*

YesNo

Please self-isolate. You do not need testing for COVID-19.

Since you don't have symptoms, you do not need testing for COVID-19 at this time. However, there’s a chance you could get sick since it’s less than 14 days since your exposure. You should self-monitor for any symptoms (fever, cough, sneezing, sore throat, or difficulty breathing). If you begin to develop these, you should take this self-assessment again.

As an additional precautionary measure, the BC Ministry of Health is asking those returning from travel outside Canada to self-isolate for 14 days. That means not going to any public places, staying at home, and not having any visitors.

Don’t share personal items like dishes, utensils, or towels, and wash your hands often.If you need more information, go to HealthLink BC's COVID-19 website.

If you are experiencing other symptoms and want assessment, go to HealthLink BC's website for care advice or call 811. They are experiencing heavy call volumes and will get to your call as quickly as they can.

Did you provide care or have close contact with a person with COVID-19 (probable or confirmed) while they were ill (cough, fever, sneezing, or sore throat)?*

YesNo

Since you don’t have any COVID-19 symptoms, you don’t need to be tested for COVID-19.

However, there’s a chance you could get sick since it’s less than 14 days since your exposure. You should self-monitor for any symptoms (fever, cough, sneezing, sore throat, or difficulty breathing).

If you begin to develop symptoms (fever, cough, sneezing, sore throat, or difficulty breathing), you should self-isolate and take this self-assessment again. If you need more information, go to HealthLink BC's COVID-19 website.

If you are experiencing other symptoms and want assessment, go to HealthLink BC's website for care advice or call 811. They are experiencing heavy call volumes and will get to your call as quickly as they can.

Did you have close contact with a person who travelled outside of Canada in the last 14 days who has become ill (cough, fever, sneezing, or sore throat)?*

YesNo

Since you don’t have any COVID-19 symptoms, you don’t need to be tested for COVID-19.

However, there’s a chance you could get sick since it’s less than 14 days since your exposure. You should self-monitor for any symptoms (fever, cough, sneezing, sore throat, or difficulty breathing).

If you begin to develop symptoms (fever, cough, sneezing, sore throat, or difficulty breathing), you should self-isolate and take this self-assessment again. If you need more information, go to HealthLink BC's COVID-19 website.

If you are experiencing other symptoms and want assessment, go to HealthLink BC's website for care advice or call 811. They are experiencing heavy call volumes and will get to your call as quickly as they can.

Since you don’t have any COVID-19 symptoms, you don’t need to be tested for COVID-19.

You should self-monitor. If you develop any symptoms (fever, cough, sneezing, sore throat, or difficulty breathing), or become aware of any potential exposures to cases of COVID-19, take this self-assessment again. If you need more information, visit HealthLink BC's COVID-19 website.

To protect yourself while out in public, wash your hands frequently, and maintain a distance of about 2 metres from others.

If you are experiencing other symptoms and want assessment, go to HealthLink BC's website or call 811. They are experiencing heavy call volumes and will get to your call as quickly as they can.

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YesNo