COVID-19 Daily Screening Questionnaire

In our ongoing effort to ensure a safe and healthy office environment for both staff and guests, please take a moment to complete this brief COVID-19 symptom screening questionnaire. Per current government guidance, all staff and guests are required to complete this assessment daily when on-site at Boughton Law offices.

  1. Do you currently have any of the following new or worsening symptoms? Symptoms should not be chronic or related to other known causes or conditions:
    • Nasal congestion or runny nose
    • Fever greater than 38 degrees Celsius or chills
    • Headache
    • Muscle pain, extreme tiredness
    • Shortness of breath
    • Cough
    • Nausea, vomiting, abdominal pain
    • Reduced, or lost sense of smell (can you smell peanut butter?)
  2. Have you had close contact with anyone with respiratory illness or a confirmed or probable/suspected case of COVID-19 in the past 14 days?
  3. In the past 14 days, have you had close contact with a person who had acute respiratory illness that started within 14 days of their close contact to someone with a confirmed case of COVID-19?
  4. Have you travelled outside of British Columbia in the last 14 days?
  5. Have you been in contact with anyone that has travelled outside of British Columbia in the last 14 days?
  6. Are you currently the subject of a provincial, territorial or local public health order?
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.