COVID-19 Pre Flight Screening - Pegasus Group Aviation

Name *

First

Last

Phone Number *

Email *

Select Country

Select State/Province

Address Line 1

Address Line 2

City

Zip/Postal Code

Temperature *

Question #1 *

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:

Fever or chills, Cough or barking cough (croup), Shortness of breath, Decrease or loss of smell or taste, Sore throat, Difficulty swallowing, Pink eye, Runny or stuffy/congested nose, Headache that’s unusual or long lasting, Digestive issues like nausea/vomiting, diarrhea, stomach pain, Muscle aches that are unusual or long lasting, Extreme tiredness that is unusual, Falling down often (for older people)

Question #2 *

In the last 14 days, have you or anyone you live with travelled outside of Canada? If you are an essential worker who crosses the Canada-US border regularly for work, select “No”

Question #3 *

In the last 14 days, have you been identiﬁed you as a close contact of someone who currently has COVID-19?

Question #4 *

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

Question #5 *

In the last 14 days, have you received a COVID Alert exposure notiﬁcation on your cell? If you already went for a test and got a negative result, select “No.”

Question #6 *

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

I have not answered YES to any of the above screening questions.

In completing the COVID-19 Pre-flight Screening I believe that the facts stated in this COVID-19 Screening are true. I understand that fines/charges/refusal of entry may be brought against anyone who makes, or causes to be made, a false statement in a COVID-19 Screening verified by a statement of truth without an honest belief in its truth