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COVID-19 Assessment Tool

Are you experiencing any of the following symptoms:

  • fever or chill
  • runny or stuffy nose
  • sore throat
  • cough
  • difficulty breathing or shortness of breath
  • nausea or diarrhea
  • loss or altered sense of taste or smell
Yes No

Do you have a lab requisition from a physician for a COVID-19 test, or has your physician sent a requisition to AHS on your behalf?

Yes No

Since the start of your symptoms, are you experiencing any of the following?

  • Fever: higher than 39 degrees for three days
  • Cough: return of cough after being cough free
  • Increasing shortness of breath or shortness of breath at rest
  • Inability to lie down because of difficulty breathing
  • Signs of dehydration such as: passing only a little urine, feeling very lightheaded
  • Chronic health conditions that you are having difficulty managing because of your current illness
Yes No

Have you recently received a positive result on an at-home rapid test?

Yes No

Take the following steps to protect yourself and others.

All Albertans have a responsibility to help prevent the spread of COVID-19. There are steps you can take to protect yourself and others.
  • Practice good hygiene: wash hands often, cover coughs and sneezes, and avoid touching your face.
  • Monitor for COVID-19 symptoms.
  • if you do develop any COVID-19 symptoms, stay home and take this self-assessment again.

For information on current public health restrictions and how to prevent the spread of COVID-19, visit