Kamloops Arts Council COVID Self Assessment COVID Screening Questions Contact Information Name: * Phone * Email * PRE-SCREENING QUESTIONS: 1. Do you have a fever of have felt hot or feverish anytime in the last 10 days? * Yes No 2. Do you have any of these symptoms: New or worsening cough? New or worsening shortness of Breath? Difficulty breathing? Sore throat or painful swallowing? Runny nose? * Yes No 3. Have you experienced a recent loss of smell or taste? * Yes No 4. Have you been in contact with any confirmed COVID-19 positive patients, or persons self-isolating because of a determined risk for COVID-19? * Yes No 5. Have you returned from travel outside of our health region in the last 14 days? * Yes No If you answered yes to number 5 - where did you travel to? 6. Is your workplace considered high risk? * Yes No Submit
