COVID-19 Screening Questionnaire

If you are are a Bespoke Audio Visual employee, independent contractor, or guest, please fill out this questionnaire prior to arriving at our offices or job sites. Learn more about how we are navigating our business and supporting our clients during COVID-19.

Please fill out this form the day-of, prior to your arrival.

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.

Temperature of 37.8. degrees Celsius/100 degrees Fahrenheit or higher.
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).
Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have).
Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have. Painful swallowing (not related to other known causes or conditions you already have).
Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have.
Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have.
Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have.
Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have). If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild muscle aches/joint pain that only began after vaccination, select “No.”
Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have). If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”
Not related to reoccurring styes or other known causes or conditions.
Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have). If you received a COVID-19 vaccination in the last 48 hours and are experiencing a mild headache that only began after vaccination, select “No.”

In the last 14 days:

This can be because of an outbreak or contact tracing, or after testing positive on a rapid antigen test.
If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”
If you already went for a test and got a negative result, select “No.”
If you are exempted from federal quarantine as per Group Exemptions, Quarantine Requirements under the Quarantine Act, select “No”.
If you answered YES to any of the above questions please go home & self-isolate immediately. You should contact your health care provider or call Telehealth Ontario at 1 (866) 797-0000 to speak to a registered nurse.
I declare that the above statements are true.