COVID-19 Screening Form

Completion of this COVID-19 screening form is mandatory for admittance to the Peterborough Memorial Centre.

You are permitted to answer this COVID-19 screening survey on behalf of yourself and members of your immediate family/household who are entering the Peterborough Memorial Centre with you today. Your answers will be used to generate a pass / fail response and may be shared with Public Health for contact tracing purposes only. If you receive a fail response, you will not be able to enter the facility and we suggest you contact Peterborough Public Health.

By answering these questions honestly, you are helping to minimize the spread of COVID-19.

Personal information is collected under the authority of Municipal Act, 2001, S.O. 2001, c. 25. The information will be used to screen for COVID-19 risk factors prior to entering The Peterborough Memorial Centre.In the event of a confirmed COVID-19 diagnosis that coincides with your visit, by completing and submitting this form, you consent to the City sharing your name and contact information on file Peterborough Public Health for purposes of contact tracing to reduce spread of COVID-19.