Have you had any unprotected contact with a person with SARS in the last 10 days? |
Have you been in a hospital closed due to SARS in the last 10 days? |
Are you in quarantine or have you been contacted by Toronto Public Health and put on home isolation? |
Have you been to China, Hong Kong, Vietnam, Singapore, or Taiwan in the last 10 days? |
Are you experiencing any of the following? |
• Myalgia (muscle aches) |
• Malaise (severe fatigue or unwell) |
• Severe headache (worse than usual) |
• Cough (onset within 7 days) |
• Shortness of breath (worse than what is normal for you?) |
• Feeling feverish, or have you had a temperature in the last 24 hours? |
Record temperature now. |
Have you been a patient or a visitor in another hospital or long-term care facility in the last 10 days? If so where? |
*All questions provided by the Ontario Ministry of Health and Long Term Care. |