Town of Huntsville COVID-19 Self-Assessment Form

The Town of Huntsville is committed to creating and maintaining municipal facilities that protects the health and safety of everyone wishing to visit or use them. To comply with the with the recommendations from the Simcoe Muskoka District Health Unit, the Town of Huntsville is requiring all individuals to complete an electronic COVID-19 Self-Assessment to determine if they are permitted to enter a Town of Huntsville facility.

Mandatory Questions

Please review the following screening questions and provide an answer to determine your status:

1. Do you have any of the following new or worsening symptoms that are not chronic or related to other known causes/conditions:

  • Fever/chills
  • Difficulty breathing/shortness of breath
  • Cough
  • Decrease/loss of smell or taste
  • Sore throat/trouble swallowing
  • Runny/stuffy nose or nasal congestion
  • Digestive issues such as nausea/vomiting/diarrhea/stomach pain
  • Extreme tiredness/unusual or long lasting muscle/head ache
  • Pink eye
  • Falling down often

2. Have you travelled outside of Canada in the last 14 days, including the United States?

3. In the last 14 days, have you been identified as a close contact with a confirmed or probable case of COVID-19?

4. In the last 14 days, have you been in close contact with a person who has acute respiratory symptoms (e.g., fever, cough, difficulty breathing) or who recently travelled outside of Canada?

5. In the last 14 days, have you been in close contact with a person who currently is experiencing any new COVID-19 symptoms, is waiting for a COVID-19 test result or travelled outside of Canada?

6. Has a doctor, health care provider, or public health unit told you that you should currently be self-isolating (staying at home)?

Contact Details

Collection of Information

This personal information is collected under the authority of the Health Protection and Promotion Act, 1990 s.5. Documents are maintained pursuant to the Municipal Freedom of Information and Protection of Privacy Act, 1991 and the Personal Health Information Protection Act, 2004. Data will  be stored in a secure electronic drive with access limited as described above.

Questions about this collection can be directed to the Deputy Clerk, Town Hall, 37 Main Street East, Huntsville, ON, P1H 1A1, 705-789-1751 extension 2258, crystal.paroschy@huntsville.ca