COVID-19 self-assessment questionnaire

For all hearing participants attending a hearing in-person on Immigration and Refugee Board premises,​ you must complete the following self-assessment questionnaire:

  • 10 days prior to the day of your hearing; and
  • if you or anyone you live with displays any of the symptoms listed in​ question 4 at any time within 10 days the day of the hearing.
  1. Has a doctor, health care provider, or public health unit told you that you should be self-isolating (staying at home) today?

    2. Yes No

  2. Have you tested positive for COVID-19 in the past 10 days?

    3. Yes No

  3. ​Are you waiting for results of a COVID-19 test?

    4. Yes No

  4. ​​Have you or anyone you live with experienced any of the following symptoms in the last 10 days?

    5. Fever and/or chills

    Yes No

    Cough or barking cough (croup)

    Yes No

    Shortness of breath

    Yes No

    Runny or stuffy / congested nose (in absence of underlying reasons
    for symptoms such as seasonal allergies and post nasal drip)

    Yes No

    Muscle aches/joint pain

    Yes No

    Extreme fatigue

    Yes No

    Sore throat

    Yes No

    Headache

    Yes No

    Nausea/vomiting and/or diarrhea

    Yes No

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  1. Have you had close contact with anyone with respiratory illness or a confirmed or probable case of COVID-19 in the past 14 days?

    2. Yes, go to question 6  No

  2. Did you wear the required and/or recommended personal protective equipment according to the type of duties you were performing (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures (AGMPs)) when you had close contact with a suspected or confirmed case of COVID-19?

    3. Yes No

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If you answered “Yes” to any questions from 1 to 4, do not go to IRB. Contact the Division immediately. We will see if your hearing can be held virtually at the same date and time. If not, we will reschedule your hearing.

If you answered “Yes” to question 5 and “No” to question 6​​, do not go to IRB. Contact​ the Division immediately. We will see if your hearing can be held virtually at the same date and time. If not, we will reschedule your hearing.​

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