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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