BBT COVID-19
Screening Questionnaire
The health and safety of Broken Bread Toronto is our top priority. Please review the entry criteria to ensure that the church remains safe and we continue to prevent the spread of COVID-19.
By entering, you are attesting to the fact that you have self-screened prior to coming to Broken Bread Toronto.
In the last 24 hours have you experienced any of the following new or worsening symptoms or signs?
Note: For the purposes of COVID-19 screening, symptoms are generally defined as unexplained or new to the individual and are not tied to a pre-existing medical condition (i.e. allergies, emphysema, etc.).
- Fever or chills
- Cough
- Difficulty breathing or shortness of breath
- Decrease or loss of smell or taste
- Sore throat
- Difficulty swallowing
- Conjunctivitis (pink eye)
- Runny or stuff / congested nose
- Unusual or long-lasting headache
- Nausea / vomiting, diarrhea, abdominal pain
- Muscle or joint aches and pains
- Not feeling well, extreme tirednessIn the last 10 days, has a doctor, health care provider or a public health unit told you that you should be self-isolating?
In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19 and/or have you received a government COVID Alert exposure notification?
If you are fully vaccinated, then answer “No”
In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19 and/or have you received a government COVID Alert exposure notification?
If you are fully vaccinated, then answer “No”
In the last 5 days, have you tested positive or are you presumed positive for COVID-19?
In the past 14 days, have you recently travelled outside the country, and have not met the government requirements for entry to Canada, including any vaccination, testing, or quarantine requirements in order to return to work?