COVID-19 SCREENING FORM

PLEASE FILL OUT COMMON GROUND’S COVID-19 SCREENING FORM BEFORE PROCEEDING WITH VISIT:

If you answered YES to any of these questions or have any new or worsening symptoms listed above, go home & self-isolate. Call Telehealth or your health care provider, to find out if you need a test. *If you have an existing health condition that gives you the symptoms you should not answer YES, unless the symptom is new, different or getting worse. Look for changes from your normal symptoms.

If you answered NO to all of these question, you have passed and can proceed with visit.

The following questions are used to screen for COVID-19 before entry into a workplace (business or organization) as per Ontario Regulation 364/20.