SCB Covid-19 Screener/Tracking Form
Students Full Name
Phone Number
Have you had close contact with anyone with acute respiratory Illness?
Clear selection
Have you been tested for COVID-19 and are awaiting results?
Clear selection
Have you tested positive for COVID-19 in the last 20 days?
Clear selection
Have you TRAVELLED outside of Canada in the last 14 days?
Clear selection
In the past 14 days, have you had close, unprotected contact with any of the following: - a sick traveler or someone who travelled outside of Canada -a person with an acute respiratory illness -a person awaiting COVID-19 testing results -a suspected or confirmed case of COVID-19?
*Close, unprotected contact is defined as having provided care, had similar close physical contact, or had lived with or otherwise had close, prolonged contact without appropriate PPE. *Asymptomatic or Surveillance testing in one of your close contacts does not apply.
Clear selection
Does your child have any of the following symptoms: *
Protocol Video
Have you watched the above Protocol Video? Videos must be viewed prior to attending classes.
Clear selection
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy