Lyonsgate Elementary Campus Screening Form
This form must be completed every day, for each child, after 5:00 a.m. and before your child arrives at school. If this online form is not completed, parents or primary caregivers are required to answer all screening questions in person when dropping students off at Lyonsgate Montessori School's Elementary campus. This form is the same as the Provincial School and Child Care Screening Tool.
Child's First Name:
Child's Last Name:
Name of parent/caregiver completing this screening form:
Are they currently experiencing any of these symptoms?
Choose any/all that are new, worsening, and not related to other known causes or conditions they already have.
Fever and/or chills (37.8C/100.0F or higher)
Cough or barking cough (croup). Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have)
Shortness of breath. Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have)
Decrease or loss of taste or smell. Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have
Nausea, vomiting, and/or diarrhea. Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have
None of the above.
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This form was created inside of Lyonsgate Montessori School.