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Welcome to CTS!
Please fill out and submit this COVID-19 Screening form.
8
Questions
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1
Name
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First Name
Last Name
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2
Email
*
This field is required.
example@example.com
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3
Phone Number
*
This field is required.
Please enter a valid phone number.
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4
What date is the program you are attending? (For overnight programs/multi-day programs, please put the start date)
*
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Date
Year
Month
Day
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5
What program have you registered for?
*
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6
Are you currently showing any of the following COVID-19 symptoms?
*
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Fever or chills Cough Difficulty breathing Sore throat Loss of sense of smell or taste Headache Extreme fatigue or tiredness Diarrhea Loss of appetite Nausea or vomiting Body aches
YES
NO
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7
Have you or anyone in your household travelled outside of Canada in the past 2 weeks?
*
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YES
NO
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8
Did you have close contact with a person with confirmed COVID-19 within the last 14 days?
*
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A close contact is someone confirmed to have COVID-19 who you live with or otherwise had close face to face contact (within 2 metres) while they had symptoms or in the 48 hours before their symptoms started. Note: This means you would have been contacted by your health authority’s public health team.
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NO
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