COVID-19 Screening Questionaire

The purpose of this questionnaire is to take preventative measures to ensure the health and safety of all Municipality of Kincardine residents. Please fill out this form before entering the building. 

Fever or chills 

Difficulty breathing or shortness of breath 


Sore throat, trouble swallowing 

Runny nose/stuffy nose or nasal congestion 

Decrease or loss of smell or taste 

Nausea, vomiting, diarrhea, abdominal pain 

Not feeling well, extreme tiredness, sore muscles 


Personal information is collected under the authority of the Municipal Act, for the purpose of creating a record to be used for contact tracing for people who enter Municipal facilities. Questions about the collection of the personal information may be addressed to the Clerk of the Municipality of Kincardine, 1475 Concession 5, R.R. 5, Kincardine, Ontario N2Z 2X6. Phone: 519-396-3468