Covid-19 Self Assessment


Are you experiencing any of the following:

  • 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

 


Are you experiencing any of the following:

  • Mild to moderate shortness of breath
  • Inability to lie down because of difficulty breathing
  • Chronic health conditions that you are having difficulty managing because of difficulty breathing


Are you experiencing 2 or more of the following symptoms (new or worsening)?

    • Fever (or signs of a fever such as chills, sweats, muscle aches and lightheadedness)
    • Cough
    • Headache
    • Sore throat
    • Painful swallowing
    • Runny nose
    • Unexplained loss of appetite
    • Diarrhea
    • Loss of sense of smell or taste
    • Or
      • Are you experiencing small red or purple spots on your hands and/or feet?


  • Are you a resident of an Atlantic province (New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador) and traveled outside of these areas within the last 14 days? Or Are you a resident of a community along the Labrador-Quebec border (Labrador City, Wabush, Fermont, the Labrador Straits area and Blanc Sablon) and traveled outside of these areas in the last 14 days?


  • In the last 14 days, did you have close contact with a person who has been confirmed as having COVID-19?


  • In the last 14 days, did you have close contact with a person who travelled outside of Newfoundland and Labrador who has become ill?


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Document name: Covid-19 Self Assessment
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June 20, 2020 9:35 pm NSTCovid-19 Self Assessment Uploaded by Waiver Administrator - info+waivers@theweegym.com IP 72.137.220.142