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THP Visitor COVID-19 Self-Screen Tool

Please Note: Each visitor must:
  • Visit during scheduled hours only for a maximum of two hours
  • Wear a mask covering your chin, mouth and nose at all times
  • Always wash your hands before entering and after leaving a patient's room and when entering and leaving the hospital
  • Remain at the patient’s bedside
  • Keep a two metre distance
  • Follow all instructions provided by THP staff for the safety of everyone at the hospital and within the community

COVID-19 Self-Screening Application

In accordance with Directive #2 for Health Care Providers issued under s. 77.7 of the Health Protection and Promotion Act (HPPA), Trillium Health Partner’s requires all individuals entering the hospital to complete the following screening questionnaire in order to manage and monitor COVID-19 infections at all THP sites, and specifically:

  1. identify individuals who are at risk of testing positive for COVID-19;
  2. enhance Trillium Health Partners’ ability to efficiently screen at all THP sites;
  3. plan, evaluate and research the efficiency and efficacy of the application and responses.

By completing the screening, you are attesting that the information given in the form is true and accurate and agree that the information may be used at a later time for the purposes above. Please note the information collected is not stored or retained by THP, and it is not linked to your medical record in any way. This information is used to facilitate a one-time entrance to the hospital. If you have any questions regarding the collection and use of this information, contact the Privacy Office at