COVID-19 Daily Screening
Email address *
Dancer/Volunteer/Staff Full Name *
Date *
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Does the person attending the activity have any of the following symptoms: fever, cough, shortness of breath/difficulty breathing, sore throat, chills, painful swallowing, runny nose/nasal congestion, feeling unwell/fatigued, nausea/vomiting/diarrhea, unexplained loss of appetite, loss of sense of taste or smell, muscle/joint aches, headache, conjunctivitis? *
Have you or anyone in your household travelled outside of Canada in the last 14 days? *
Have you or your children attending the program had close unprotected* contact (face-to-face contact within 2 metres/6 feet) with someone who is ill with cough and/or fever? *
Have your or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *
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