Daily Screening For ABA Participation
This form is time stamped and must be completed every attendance at an ABA session, before the participant enters the facility.
* Required
Email address
*
Your email
Person conducting the screening (Parent, Participant, or Staff Name)
*
Your answer
Participant's Name
*
Your answer
Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days?
*
Yes
No
Have you returned from travel outside of Canada in the past 14 days?
*
Yes
No
Are you experiencing any of the following symptoms of Covid-19:
*
Fever (temperature of 37.8°C / 100.4°F or greater in the last 24 hours)
New or worsening cough
Shortness of breath or any trouble breathing (dyspnea)
Sore throat and/or difficulty swallowing
Runny nose, or nasal congestion
Nausea/vomiting, diarrhea, abdominal pain
Loss of any ability to taste or smell
Experiencing headaches or feeling at all unwell
Unexplained fatigue / malaise /myalgia
None of the above
Required
Please complete the screening by checking the appropriate box:
*
Participant has no symptoms of Covid-19 and will be attending ABA's session today.
Participant is experiencing symptoms of Covid-19 and will not be attending ABA's session today.
Participant has no symptoms of Covid-19 but will be staying home today.
Required
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