PI COVID Screening Form

You must complete this COVID screening form in order to be allowed access to the Perimeter Institute building. After completing this form, you will receive a confirmation email which you must show at reception to be allowed access to the building. Paper forms are also available at the building. This form must be submitted the day you intend to visit the Perimeter Institute building and is only valid for that day.

All Perimeter residents must provide proof of vaccination prior to entry, submit your proof here. Short-term visitors may show their proof of vaccination at the front desk upon entry.

You may experience side effects following your COVID-19 vaccine, this is common and normal. Learn more about common side effects here. If you are experiencing side effects and feel well enough to work, you are encouraged to do so from home. If symptoms worsen, continue past 48 hours, or if other symptoms develop you must leave the building immediately, self-isolate at home and contact your health care provider. 

1. Have you been fully vaccinated against COVID-19?
1. Have you been fully vaccinated against COVID-19?
*This means you have received a full series of a vaccine or a combination of vaccines accepted by the Government of Canada or World Health Organization AND received your last dose at least 14-days ago.
Vaccination Status
symptoms question
2. In the last 5 days (or currently), have you experienced any new or worsening symptoms noted below?

*Select “Cleared” if you have already completed your isolation period of 5 days, AND:
you don’t have a fever, AND
- your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)

Symptoms checklist
  • Fever and/or chills
  • Difficulty breathing or shortness of breath
  • Cough or barking cough (croup)
  • Sore throat, trouble swallowing
  • Runny nose/stuffy nose or nasal congestion
  • Decrease or loss of smell or taste
  • Nausea, vomiting, diarrhea, abdominal pain
  • Not feeling well, extreme tiredness, sore muscles (not related to getting a COVID-19 vaccine in the last 48 hours)
  • Pink eye
  • Headache that's unusual or long lasting (not related to getting a COVID-19 vaccine in the last 48 hours)
3. Have you travelled outside of Canada in the past 14 days?
3a. Have you been advised to quarantine per the federal quarantine requirements?
3b. If you consent to participate in PI’s rapid antigen testing program select "Consent". If you do not consent you must work from home for 14 days following travel.
*Participants must take 1st test prior to entering PI and re-test twice per week within the first 14 days following return to Canada. Testing details may be found on PION.
3c. Have you completed a rapid antigen test in the last 72 hours with a negative result?
4. In the last 5 days, have you tested positive for Covid 19?
*This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test, or home-based self-testing kit.
5. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
6. Do any of the following apply?
  • You live with someone who is currently isolating because of a positive COVID-19 test
  • You live with someone who is currently isolating because of COVID-19 symptoms
  • You live with someone who is isolating while waiting for COVID-19 test results
Select “No” if:
  • You are 18 or older and have received your booster, and/or
  • You are 17 or younger and are fully vaccinated, and/or
  • You completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test), and/or
  • your household member is isolating because of COVID-19 symptoms but has already tested negative on one PCR or rapid molecular test, or two rapid antigen tests