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COVID-19 Town of St. Marys Contact Tracing and Screening Form

We require all guests, contractors and employees to complete screening prior to entering our facilities. Please complete this form for contact tracing and screening purposes.

Collection of Personal Information: Personal information on this form is collected in accordance with the Municipal Freedom of Information and Protection of Privacy Act. It is to be used for the purpose of administering health and safety precautions within municipal facilities. Any questions regarding the collection, use and retention of personal information on this form can be directed to the Town of St. Marys Clerk (clerksoffice@town.stmarys.on.ca).

The symptoms listed here are the most commonly associated with COVID-19. Anyone who is sick or has any symptoms of illness, including those not listed below, should stay home and seek assessment from their health care provider if needed.

Are you currently experiencing two or more of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.

• Nausea, vomiting, and/or diarrhea: Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have
• Muscle aches/joint pain: Unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
• Extreme tiredness: Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
• Sore throat: Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)
• Runny or stuffy/congested nose: Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have
• Headache: New, unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)

1. Are you currently experiencing any of these symptoms? 
   Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.
   • Fever and/or chills: Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
   • Cough or barking cough (croup): Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
   • Shortness of breath: Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
   • Decrease or loss of taste or smell: Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
2. In the last 10 days, has someone you live with: been sick with symptoms associated with COVID-19 and/or tested positive for COVID-19 (on a rapid antigen test or PCR test)?
3. In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? 

Please note:
If any of the following apply to you, you do not need to self-isolate or get tested. However, it is recommend that you pay extra attention to your health and note if anything changes.

1. In the last 14 days, you have travelled outside of Canada. Not applicable if exempt from federal quarantine requirements as directed by the border agent at your point of entry (for example, you have two or more doses of a COVID-19 vaccine and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work).
2. In the last 10 days, you have been identified as a “close contact” of someone who currently has COVID-19 (confirmed by a PCR or rapid antigen test). Not applicable if public health has advised you that you do not need to self-isolate.
3. In the last 10 days, you received a COVID Alert exposure notification on your cell phone.

If you are currently experiencing any of the following issues, call 911 or go directly to your nearest emergency department: Severe difficulty breathing, severe chest pain, feeling confused or unsure of where you are, losing consciousness.