COVID-19 Ag Rapid Test

Within the past 10 days, have you EITHER tested positive for COVID-19 OR have you experienced any of the following symptoms: • Fever • Cough • Shortness of breath • Loss of sense of taste or smell • Sore throat (Adults only) • Runny nose (Adults only)

If you answered “YES” to any part of question 1: you must not enter the site for the purposes of
supporting or visiting a patient.
Due to the vulnerable environment of AHS sites and for the protection of all in our care, AHS requires
that in addition to any requirements in CMOH Order 1-2022:
• Designated support persons/visitors who have tested positive* for COVID-19 and are
experiencing COVID-19 symptoms not enter a site for at least 10 days from the onset of
symptoms AND have had their symptoms resolve* before entering.
• Designated support persons/visitors who test positive for COVID-19* but are asymptomatic*
not enter a site until a minimum period of 10 days have passed from the day they took a Health
Canada-approved test that confirmed they are positive for COVID-19. If they develop
symptoms, they must not enter a site for at least 10 days from the onset of symptoms AND
have had their symptoms resolve* before entering.
*COVID test – means a Health Canada approved rapid test or approved lab based PCR test.
*Symptoms Resolve - means the state when a person’s COVID-19 symptoms improve and the person
remains fever free for a period of 24 hours without using fever reducing medications.
*Asymptomatic - means a person who is not exhibiting COVID-19 core symptoms.

Have you travelled outside Canada in the last 14 days AND have you been directed to quarantine?
In the last 14 days, have you had any known close contact with someone who has a positive or probable case of COVID-19?

Thanks for submitting!