COVID-19 Questionnaire Willow Valley

Name*

First NameLast Name

Check this box to respond "No" to all. Once selected, scroll down and click "Submit".

"No" to all

1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

Fever or chills*

YesNo

Difficulty breathing or shortness of breath*

YesNo

Cough*

YesNo

Sore throat, trouble swallowing*

YesNo

Runny nose/stuffy nose or nasal congestion*

YesNo

Decrease or loss of smell or taste*

YesNo

Nausea, vomiting, diarrhea, abdominal pain*

YesNo

Not feeling well, extreme tiredness, sore muscles*

YesNo

2. Have you travelled outside of Canada in the past 14 days?*

YesNo

3. Have you had close contact with a confirmed or probable case of COVID-19?*

YesNo

COVID-19 Questionnaire Willow Valley Golf