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.
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?
Fever (37.8 degrees Celsius or greater)
New or worsening cough
New or worsening shortness of breath
Decrease or loss of taste or smell
Unexplained fatigue / muscle soreness / pain / myalgia
New or worsening digestive symptoms, including nausea, vomiting, diarrhea, & or abdominal pain
Pink eye / Conjunctivitis
Runny nose, or nasal congestion - without other known cause
None of the above
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.
A copy of your responses will be emailed to the address you provided.
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