Gymtastiks - Daily Screening Form
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Name of child attending class
Date of class attending
Do you, or your child attending today, have any of the following symptoms?
Shortness of breath or difficulty breathing
Runny nose or congestion
Nausea, vomiting or diarrhea
New loss of sense of taste or smell
Have you or anyone in your household traveled to a province or territory outside of Saskatchewan in the past 14 days?
Yes (if yes, self-monitor for 14 days)
Have you, or anyone in your household, in the past 14 days travelled to a community in Saskatchewan with a COVID-19 outbreak?
Have you, or anyone in your household been in direct unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?
Have you, or anyone in your household travelled internationally and/or been instructed to self-isolate for any other reason?
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