PI COVID Screening Form

By provincial mandate 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 in case you are unable to complete this form or cannot show the confirmation email to reception. This form must be submitted the day you intend to visit the Perimeter Institute building and is only valid for that day.

All residents and visitors to Perimeter must self-declare their vaccination status prior to entry. Submit your declaration here

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.
Do you have an approved accommodation (through People & Culture)?
1a. Do you consent to participate in rapid antigen testing? Testing may be completed off-site or onsite and requires a negative test result.
symptoms question
2. 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.
Symptoms checklist
-    Fever or chills
-    Difficulty breathing or shortness of breath
-    Cough or barking cough (croup)
-    Sore throat, trouble swallowing
-    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)
-    Falling down often
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 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit?
*If you have since tested negative on a lab-based PCR test, select “No”.
5. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
6. In the last 10-days, have you been identified as a “close contact” of someone who currently has COVID-19?
*If public health has advised you that you do not need to self-isolate select No.
7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
If this 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”.
8. In the last 10 days, have you received a COVID Alert exposure notification on your cell phone?
If you have already gone for a test and got a negative result, select “No.”
9. Have you conducted a rapid antigen test OR PCR test in Ontario and received a negative result in the past 72 hours?