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UPDATED COVID-19 Self Screening Questionnaire - Student
Parents/Guardians/Students MUST use this questionnaire daily to decide if the student should attend school
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Risk Assessment: Initial Screening Questions
Name of Child *
Grade Level of Child *
1) Do you, or your child attending the program, have any of the below symptoms: *
Yes
No
Fever (37.8 degrees or higher and/ or Chills
Cough (Continuous, more than usual, making a whistling noise when breathing)
Shortness of Breath / Difficulty Breathing
Sore throat
Chills
Painful swallowing
Feeling unwell / Fatigued
Nausea / Vomiting / Diarrhea
Unexplained loss of appetite
Loss of sense of taste or smell
Muscle / Joint aches
Conjunctivitis (Pink Eye)
2) In the last [5, 10] days has the student/child experienced any of these symptoms? If the student/child is fully vaccinated OR 11 years old or younger, use 5 days • If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised, use 10 days *
Yes
No
Sore throat or difficulty swallowing
Runny or stuffy/congested nose
Headache
Extreme tiredness
Muscle aches or joint pain
Nausea, vomiting and/or diarrhea
3) In the last [5, 10] days has the student/child tested positive for COVID-19? This includes a positive COVID-19 test result on a lab-based PCR test, rapid antigen test or home-based self-testing kit. • If the student/child is fully vaccinated OR 11 years old or younger, use 5 days • If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised, use 10 days.  ***If the individual isolating has not tested positive for COVID-19 and only has one of these symptoms: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, extreme tiredness, muscle aches or joint pain, nausea, vomiting and/or diarrhea, select “No.” *
4) Do any of the following apply? • The student/child lives with someone who is currently isolating because of a positive COVID-19 test • The student/child lives with someone who is currently isolating because ofCOVID-19 symptoms • The student/child lives with someone who is currently isolating while waiting for COVID-19 test results. ***** If the individual isolating has not tested positive for COVID-19 and only has one of these symptoms: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, extreme tiredness, muscle aches or joint pain, nausea, vomiting and/or diarrhea, select “No.” *
5) Has the student/child been identified as a “close contact” of someone who currently has COVID-19 and been advised to self-isolate? *****If public health guidance provided to you has advised you that you do not need to self-isolate, select “No.” *
6) Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. *
7) Do any of the following apply? • In the last 14 days, the student/child travelled outside of Canada and was told to quarantine • In the last 14 days, the student/child travelled outside of Canada and was told to not attend school/child care • In the last 14 days, someone the student/child lives with has returned from travelling outside of Canada and is isolating while awaiting results of a COVID-19 test. Please note that if the child/student is not fully vaccinated but is exempt from federal quarantine because they travelled with a vaccinated companion, they must not attend school or child care for 14 days. Select “yes” if this applies to the student/child. *
* "UNPROTECTED" means close contact without appropriate personal protective equipment (PPE).
Results of screening questions
If you answered “YES” to ANY question, your child cannot go to school or child care. Contact your school/child care provider to let them know that your child will not be attending school today.

See The Provincial Website for Isolation and Testing requirements.

If you have answered "NO" to all the above questions, you may attend school.
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