Al-Zahra COVID-19 Questionnaire
Please note, you will be asked the following questions at time of registration for all Al-Zahra programs. Please note that children under 10 are currently not allowed to attend.
Do you currently exhibit any of the symptoms below?
- *Severe difficulty breathing (e.g., struggling for each breath, speaking in single words)
- Severe chest pain
- Having a very hard time waking up
- Feeling confused
- *Lost consciousness
- Shortness of breath at rest
- Inability to lie down because of difficulty breathing
- Chronic health conditions that you are having difficulty managing because of your current respiratory illness
- Chills
- *Painful swallowing
- Stuffy nose
- Headache
- Muscle or joint ache
- Feeling unwell, fatigue or severe exhaustion
- *Nausea
- Vomiting
- Diarrhea or unexplained loss of appetite
- Loss of sense of smell or taste
- Conjunctivitis (pink eye)
In the past 10 days, have you experienced any of the following
- Fever
- New onset of cough or worsening of chronic cough
- New or worsening shortness of breath
- New or worsening difficulty breathing
- Sore throat
- Runny nose
In the past 14 days, did you return from travel outside of Canada, or did you have close contact with someone who is confirmed as having COVID-19?
- Yes
- No