COVID-19 Health Screening for the public or visitors

CovidScreeningFormVisitors

The health and safety of our staff and community continues to be our top priority. The following health screening form must be completed BEFORE entering recreation and culture facilities, and Town Hall. This form must be completed and submitted by the person who is planning to physically visit or report into a town facility. Parent(s) accompanying child(ren) must complete and submit one form per child.

Note: Existing health and safety protocols remain in place including health screening, contact tracing, physical distancing, face coverings, and proper hygiene to prevent the spread of the virus. Respectful behaviour is also expected towards all visitors, staff and volunteers in accordance with the town's Rzone Procedure


Screening questions

Fever and/or chills; difficulty breathing or shortness of breath; cough or barking cough (croup); decrease or loss of smell or taste; fatigue

 

 

 

If public health has advised you that you do not need to self-isolate, select 'No'. If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select 'No'

 

If you have since tested negative on a lab-based PCR test, select 'No'.

 

If you are have already gone for a test and got a negative result, select 'No' or if you’re fully vaccinated, select 'No'

 

If you’re fully vaccinated or have been tested positive for COVID-19 in the last 90 days (and since been cleared), select 'No'

 

If you’re fully vaccinated or have been tested positive for COVID-19 in the last 90 days (and since been cleared), select 'No'.

 

If the individual experiencing mild symptoms after receiving a COVID-19 vaccination in the last 48 hours, select 'No'. If fully vaccinated or have tested positive for COVID-19 in the last 90 days and since cleared, select 'No'.

 

Participant information

 
 
 

 

Personal information on this form is collected under the authority of The Municipal Act for the purpose of gathering information for this application. Questions about the collection should be sent to Oakville at 1225 Trafalgar Road, Oakville, Ontario L6H 0H3 or by phone at 905-845-6601.