COVID -19 Screening Question
If you answer YES to any of these questions you may not attend your class in person at PDA today.
For quick and easy access to this screening form download our new APP:
Sign in to Google
to save your progress.
1. Has your dancer travelled outside the Country in the last 14 days and are required to quarantine?
2. Has a doctor, healthcare provider, or public health unit told you that your dancer should currently be isolating (staying at home)?
3. In the last 14 days, has your dancer been identified as a "close contact" of someone who currently has COVID-19?
4. In the last 14 days, have you or someone in your immediate family received a COVID Alert exposure notification on your cell phone?
5. Is anyone your dancer lives with currently experiencing any new COVID-19 symptoms, feeling ill, and/or waiting for test results after experiencing symptoms? (If your dancer is fully vaccinated please always answer No to this question)
6. Does your child have any of the following new or worsening symptoms or signs? Check only those that you are experiencing. (Symptoms should not be chronic or related to other known causes or conditions)
(1) Fever or chills (37.8 degrees C / 100 degrees F of higher)
(2) Difficulty breathing or shortness of breath
(3) Cough or Barking Cough (Croup)
(4) Decrease or loss of smell or taste
(5) Digestive Issues like nausea, vomiting, diarrhea, abdominal pain
(6) Extreme Tiredness (Unusual fatigue, lack of energy)
(7) Muscle Aches (Unusual, long-lasting)
(8) Headache (Unusual, long-lasting)
MY DANCER HAS NONE OF THE ABOVE SYMPTOMS TODAY
Results of Screening Questions
- If you answer NO to all questions 1 through 6, you have passed and may attend dance in-studio today.
-if you answer YES to any question #1 through 6 you have not passed and you cannot attend dance in-studio today. We must advise you to self-isolate at home and contact a health care provider to get advice or an assessment, including if a COVID-19 test is required.
- If any of the answers to these screen questions change during the day, this screening result is no longer valid and you will need to screen again, wherever necessary.
RETURNING TO DANCE IN-STUDIO
- If you have selected YES to Question #1 to 4 or checked any of the symptoms in Question #6 a negative Covid-19 test, or 14 days of self-isolation, or a non-Covid diagnosis from a medical practitioner is required to return to in-studio classes.
- If you have answered YES to question #5 you may return to in-studio classes when the person in your household receives a negative COVID-19 test result, or is cleared by your local public health unit, or diagnosed with another illness.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service