COVID-19 ASSESSMENT

Daily Log Sheet for Instructors and Students

Covid-19 Self Assessment: Have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 in the last 14 days? 

Are you experiencing any of the following symptoms?

· Fever

· New onset of cough

· Worsening chronic cough

· Shortness of breath

· Difficulty breathing

· Sore throat

· Difficulty swallowing

· Decrease of loss of sense of taste or smell

· Chills

· Headaches

· Unexplained fatigue/malaise/muscle aches (myalgias)

· Nausea/vomiting, diarrhea, abdominal pain

· Pink eye (conjunctivitis)

· Runny nose or nasal congestion without other known cause

· Have you travelled outside of Canada in the last 14 days?

If answered yes to any of the above questions, please take the appropriate measures outlined by Health Canada.

 I attest that the information provided is correct and accurate:

Student's Signature: _______________

Instructor's Signature: _____________

Note : One Instructor and One Student will be in the car for training.

Bring a face covering mask to wear inside the car.

Sanitize your hands before entering the car (bring your own sanitizer if you would like)

Undergo temperature checks before entering the car.

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