Daily questionnaire

This questionnaire is designed to locate potential geographic areas where the coronavirus is spreading in Québec. You will be asked about potential symptoms of the virus.

Please fill out the questionnaire every day and separately for each family member. It is important to fill out the questionnaire also in cases where you and your family are feeling well and do not experience any symptoms.

This survey is anonymous and all data will be used solely for tracking the spread of the virus.

You will not have any return of information from the answers you provide in the questionnaire.

Please understand that this questionnaire cannot diagnose coronavirus infection, moreover this questionnaire does not constitute any form of clinical care. All official governmental information can be found at https://msss.gouv.qc.ca/professionnels/maladies-infectieuses/coronavirus-2019-ncov/, the official MSSS site dedicated to COVID19 or by calling the Quebec information line on COVID-19, available Monday to Friday from 8:00 to 6:00 : 1 877 644 4545.

We thank you for your participation,
CIUSSS West-Central Montreal

* We are taking every measure to keep the privacy of participants.
** There are 15 questions.
*** We invite you to share this questionnaire with friends and family.