COVID-19 VISITOR PRE-SCREENING QUESTIONNAIRE

In Step-3 of the Ontario Roadmap to Reopening, Crate’s is required to conduct active COVID-19 pre-screening of all visitors using the following questionnaire. If you do not pass the assessment you must stay home.

  • Pre-screening questionnaires must be completed on the day of your appointment, before you come to Crate’s
  • Every visitor who is 18 years of age or older must complete his/her own Pre-Screening Questionnaire
  • Where a person under the age of 18 is visiting Crate’s with a parent or guardian, the parent or guardian may complete the questionnaire on behalf of the minor



Questionnaire

(1)     Are you experiencing any of these issues? Call 911 if you are.

  • Severe difficulty breathing (struggling for each breath, can only speak in single words)
  • Severe chest pain (constant tightness or crushing sensation)
  • Feeling confused or unsure where you are
  • Losing consciousness



(2)     Are you currently experiencing any of these symptoms that are new, worsening, and are not related to other known causes or conditions you already have?

  • Fever and/or chills (temperature of 37.8ºC / 100ºF or higher)
  • Cough, barking cough or croup (continuous, making a whistling noise with breathing)
  • Shortness of breath (out of breath, unable to breathe deeply)
  • Decrease or loss of taste or smell
  • Muscle aches/joint pain (unusual, long lasting , not related to getting a COVID-19 vaccine in the last 48 hours)
  • Extreme tiredness or fatigue that is unusual



(3)     In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)?




(4)     Has a doctor, health care provider, or a Public Health Unit told you that you should currently be isolating by staying at home (this can be because of an outbreak or contact tracing)?




(5)     In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit (if you have since tested negative on a lab-based PCR test, select "No”)?





NO > If you answered “no” to all questions, sign below to self-certify that you are clear for your appointment.

YES > If you answered “yes” to any questions your appointment will be cancelled. Stay home, self-isolate and contact your healthcare provider or Telehealth Ontario (1-866-797-0000).





Who are you Visiting? *

Please Select
Your Name *
Your Email *
Your Phone *




When You Arrive

  • Park in the designated Customer Parking area in front of our office.
  • Before entering our building, please put on your mask
  • Apply hand sanitizer
  • Check-in with reception and show Crate’s staff member your email confirmation with green “You can go” result
  • Sign our visitor log for contact tracing
  • Ensure you wear your mask and maintain 2M physical distance at all times while at Crate’s.
  • Observe all COVID-19 signage throughout the property and follow staff directions.


Covid-19: What to Expect When Visiting Crate’s      Learn More