COVID-19 Screening & Tracking Form
We require this form to be filled out prior to anyone entering the building.

All parents will be asked the following questions for themselves & their children.
Email *
Name *
Phone number
1: Have you traveled outside of Canada in the last 14 days? *
2: Have you tested positive for COVID-19 in the past 14 days? *
3: Have you had close contact with someone who has tested positive for COVID-19 in the past 14 days without wearing appropriate Personal Protective Equipment? *
4: Have you lived or worked in a facility known to be experiencing an outbreak of COVID-19 in the past 14 days? *
5: Are you experiencing any of the following symptoms? *
Required
COVID-19 Screening Results

If response to all the screening questions is NO - COVID-19 Screen Negative


If response to any of the screening questions is YES - COVID-19 Screen Positive


COVID-19 Screen Positive: Student will be sent home & we recommend a 2-week quarantine & COVID-19 test.
Date:
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy