Mississauga Chinese Alliance Church (English Worship)

Questionnaire

1) Do you have any of the following new or worsening symptoms or signs?

Fever, Cough, Trouble breathing, Decrease or loss of taste or smell, Nausea, vomiting or diarrhea, Very tired, sore muscles or joints.

2) Does anyone in your household have one or more of the above symptoms and / or are waiting for test results after experiencing symptoms?

3) In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?

4) In the last 10 days:

a) Have you been notified as a close contact of someone with COVID-19 or been told to stay home and self-isolate?

b) Has someone you live with been identified as a close contact of someone with COVID-19 AND been told to self-isolate?