COVID-19 Screening Questionnaire
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Note

If the individual being screened is immunocompromised or living in a highest risk congregate care setting (for example, a hospital school, an Education and Community Partnership Program), this is not the correct screening tool. The correct tool can be found at https://www.ontario.ca/school-screening/.

Staff, students, children, and visitors should screen every day before going to school or child care. Parent(s)/guardian(s) can fill this out on behalf of a child or student.

Anyone who is feeling sick or has any new or worsening symptoms of illness, including those not listed in this screening tool, should stay home until their symptoms are improving for at least 24 hours (or 48 hours for nausea, vomiting, and/or diarrhea) and seek assessment from their health care provider if needed.

It is strongly recommended that all individuals age 2 or older wear a well-fitted mask in indoor public settings. This includes school and child care due to the additional risk of Respiratory Syncytial Virus (RSV) and influenza.

Children age 2 to 5 should only wear a mask if they are supervised, can safely tolerate masking, and can put their mask on and take it off. 

Today's Date *
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Room Colour *
Name of child / staff / essential visitor: *
Are you filling in the form for a child or as a staff member / visitor? *
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