Health Check – Feb Update Redeemer Health Check (COVID-19) Please complete this form each day you plan to come to campus, prior to your arrival. If you live on campus, please complete this form every day. Information provided may be reviewed by Redeemer's Campus Care Registered Nurse.Personal InformationName* First Last Email (@redeemer.ca if you are a student or employee)* I am astudent living in residencestudent not living on campusemployeeContact Phone #*Self-AssessmentPlease answer the questions below as accurately as possible. Please note that the information gathered here may be used by Redeemer to monitor health trends among its students and employees. Information will be kept securely, access will be limited to a small number of Redeemer staff on a need-to-know basis, and information will be deleted as soon as it is no longer required. If you indicate that you have symptoms, you may be contacted by Redeemer's Campus Care registered nurse.Please call 911 immediately!Are you experiencing any of the following symptoms?*(check all that apply) 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 of where you are Losing consciousness Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius/100.4 degrees Fahrenheit or higher) or chills? Cough that's new or worsening — continuous, more than usual — or a barking cough, or making a whistling noise when breathing? Shortness of breath — out of breath, unable to breathe deeply Lost sense of taste or smell Sore throat not related to seasonal allergies or other known causes or conditions Difficulty swallowing Runny, stuffy, or congested nose not related to seasonal allergies or other known causes or conditions Pink eye Headache that is unusual or long lasting Digestive issues like nausea/vomiting, diarrhea, stomach pain not related to other known causes or conditions Muscle aches that are unusual or long lasting Extreme tiredness that is unusual and unexplained — fatigue, lack of energy Falling down often None of the above When did your symptoms start?*TodayWithin the past 6 daysMore than a week ago (7-11 days ago)About two weeks ago (12-14 days ago)More than two weeks ago (15 days or more ago)I don't rememberHave you had close contact (that is, living in the same household, or being less than two metres away in the same room or area) in the past 14 days with anyone who has a confirmed case of Covid-19, or have you been alerted by the Covid app?*YesNoHave you travelled outside Canada in the past 14 days?*YesNoIs anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? (If you live on campus, this refers only to your direct roommate, not your dormmates.)*YesNoIf you have been within 6 feet of the ill person, without your mask on, for more than 15 minutes and you are experiencing possible symptoms of COVID-19, please isolate until you have been in contact with the Campus Care Nurse. If you are not experiencing symptoms, you are not required to isolate unless the ill person's test result comes back positive.