COVID-19 Public Self-Screening Tool

COVID-19 Self-Screening Tool

Welcome! Please help us continue to make Newmarket a safe place to work, live, and play by completing a self-assessment before entering. By answering these questions, you are helping protect yourself, Town of Newmarket staff, and your fellow residents

Terms and Conditions

I acknowledge Covid-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious and that I have an elevated risk of contracting Covid-19 by being around other people in a public setting and I hereby assume the risks with respect to acquiring COVID-19 inherent in my entering a Town of Newmarket facility, including the associated risk of death, illness or severe bodily injury that may accompany Covid-19.

I hereby release and save harmless the Corporation of the Town of Newmarket and its employees and representatives from any and all claims and demands associated with my acquiring Covid-19, from my participation in Town of Newmarket programs or entering a Town of Newmarket facility, due to any cause whatsoever, including negligence, breach of contract, mistakes or errors in judgment. This Release of Liability shall be binding upon my heirs, next of kin, executors, administrators, assigns and representatives.

COVID-19 Screening Form for

Question 1

In the last 5 days, have you experienced any of these symptoms?

  • Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
  • Cough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
  • Shortness of breath - Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
  • Decrease or loss of taste or smell - Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
  • Muscle aches/joint pain - Unusual, long-lasting (not related to getting a COVID-19 vaccine in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
  • Extreme tiredness - Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
  • Sore throat - Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)
  • Runny or stuffy/congested nose - Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have
  • Headache - New, unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)
  • Nausea, vomiting and/or diarrhea - Not related to irritable bowel syndrome, anxiety, menstrual cramps, medication side effects, or other known causes or conditions you already have
Question 2

In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?

Question 3

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

Question 4

In the last 5 days, have you tested positive for COVID-19?

Note

This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test, or home-based self-testing kit.

Question 5

Do any of the following apply?

You live with someone who is currently isolating because of a positive COVID-19 test.

You live with someone who is currently isolating because of COVID-19 symptoms.

You live with someone who is waiting for COVID-19 test results.

Note

Select "No" if:

  • You are 18 or older and have received your booster, and/or
  • You are 17 or younger and are fully vaccinated, and/or
  • You completed your isolation after testing positive within the last 90 days (using a rapid antigen, rapid molecular, or PCR test), and/or
  • Your household member is isolating because of COVID-19 symptoms but has already tested negative on one PCR or rapid molecular test, or two rapid antigen tests.

Has any member of your household entering our facility answered "Yes" to any of the above questions?

Not cleared to enter

As recommended by York Region Public Health, please go home to self-isolate immediately and contact your health care provider or York Region Public Health at 1-800-361-5653 to find out if you need a COVID-19 test.

If you are a contractor, please contact your Supervisor to advise you are restricted from entering our facility.

Cleared to enter

Please display to staff member before entering

Adhere to Public Health guidelines by properly wearing a face covering, washing/sanitizing your hands frequently, and maintaining a distance of at least 2 meters from others