Ledingham Chevrolet Buick GMC Workplace ScreeningCovid 19 Government Required Screening Date* Date Format: MM slash DD slash YYYY Name* First Last 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. Select all that apply None of the Below Fever and chills Difficulty breathing or shortness of breath Cough Sore throat, trouble swallowing Runny nose/stuffy nose or nasal congestion, decrease or loss of smell or taste Nausea, vomiting, diarrhea, abdominal pain Not feeling well, extreme tiredness, sore muscles 2. Have you travelled outside of Canada in the past 14 days?*NoYes3. Have you had close contact with a confirmed or probable case of COVID-19?*NoYesSend me a copy of my responsesNoYesEmail* Lead IDSession IDOpt Out
