COVID-19 Alberta Health Checklist
*Please fill one form per family*

Will be updated to reflect any Government of Alberta and Alberta Health Services changes to questions and requirements.

Do you, or anyone in your household have any of the following symptoms:
Have you, or anyone in your household traveled outside of Canada in the last 14 days?
Have you, or anyone in your household had close contact with a confirmed case of Covid-19 in the last 14 days?