BC COVID-19 Self-Assessment Tool - International Water Guard

International Water-Guard

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exceptional water en route

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International Water-Guard

exceptional water en route

Home Page
About Us
Products
Customer Service
Quality
- Labels
- Our Certification
Contact
- How to Reach Us
- Events
X (formerly Twitter)
Instagram

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Supplier Login

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BC COVID – 19 | Self – Assessment Tool

Name *

First

Last

Date *

Phone

Company

Are you experiencing any of the following: • Severe difficulty breathing (e.g. struggling to breathe or speaking in single words) • Severe chest pain • Having a very hard time waking up • Feeling confused • Losing consciousness *

yes
no

Are you experiencing any of the following: • Mild to moderate shortness of breath • Inability to lie down because of difficulty breathing • Chronic health conditions that you are having difficulty managing because of difficulty breathing *

yes
no

Are you experiencing cold, flu or COVID-19-like symptoms, even mild ones? *

yes
no

Have you travelled to any countries outside Canada (including the United States) within the last 14 day *

yes
no

Did you provide care or have close contact with a person with confirmed COVID-19? *

yes
no

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