Covid-19 Health Declaration

I, ____________________________________ signed at ____________________

print name city

this _______ day of ________________, ____, understand that Covid-19 is a serious virus
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that has caused a pandemic, and that I must answer the following questions truthfully.

Answering YES to any of the following questions means that you will NOT be able to attend an
IELTS test or appear in any office or work environment where English Testing Canada operates, and
will further agree to avoid personal contact with others until you are able to answer NO to all the
following questions.

English Testing Canada agrees that any test-taker who answers YES to any of the following
questions will be permitted to reschedule their IELTS test without penalty to a later date.

Have you travelled outside of Canada in the 14-day period prior to your test day?

YES NO

Have local health authorities asked you to stay in quarantine?

YES NO

Have you been in contact with anyone who has Covid-19 in the past 14 days?

YES NO

Do you have a fever, persistent cough, difficulty breathing, or other flu-like symptoms?

YES NO

By signing this declaration, I certify that the answers I have circled above are truthful.

Signature: _____________________________________________________

Covid-19 Candidate Declaration 1.2