COVID 19 – Self Isolation Questionnaire Name(required) Email(required) Student Number(required) Phone Number(required) Building(required) Building 1 Building 2 Building 3 Building 4 Building 5 Building 6 Room Number(required) Dietary/allergies consideration(s): Why are you self-isolating?(required) Returning from travel outside of Ontario. Have had direct contact with someone who has tested positive for COVID-19. Have had direct contact with someone who is under care for suspected exposure to COVID-19. Experiencing symptoms of COVID-19 / illness. Have been informed by Public Health Authority or Health Care professional to isolate.