1. Do you have any of the following new or worsening symptoms or signs?
Symptoms should not be chronic or related to other known causes or conditions.

• Fever or chills
  Yes No
• Difficulty breathing or shortness of breath
  Yes No
• Cough
  Yes No
• Sore throat, trouble swallowing
  Yes No
• Runny nose/stuffy nose or nasal congestion
  Yes No
• Decrease or loss of smell or taste
  Yes No
• Nausea, vomiting, diarrhea, abdominal pain
  Yes No
• Not feeling well, extreme tiredness, sore muscles
  Yes No

2. Have you travelled outside of Canada in the past 14 days?

3. Have you had close contact with a confirmed or probable case of COVID-19?

Valid proof of vaccination will be required prior to clients entering the home for PDI and Review Inspections. In addition, before Eden Oak staff/trade partners enter the home, valid proof of vaccination for everyone remaining in the home will be required before service work commences.