Nature School Elementary Daily Home Screening Form
Please complete form daily prior to coming to school. This elecromic screening process will help minimize contact with staff as well as keep drop off times quick and efficient. We trust that we are all working together to ensure the safety of each student and staff, as well as the greater community. Thank you for taking this extra step to help!

This form is time stamped, so it will automatically save the date and time you entered your information.

If you answer YES to any of the these questions, let us know, go home and self-isolate right away.
Call your health care provider or the COVID-19 Info-Line at 905-688-8248 and a public health professional
will give you detailed instructions to follow to protect you, your family and members of the public

Jen 289-990-2939
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Child(ren) name(s) *
Have you, or anyone in your immediate family have any of the following : *
New cough or a cough that is getting worse
Difficulty breathing
Shortness of breath (even when sitting or walking regularly)
Sore throat (not due to allergies)
A runny or congested nose (not due to allergies)
Unusual level of fatigue
Unusual headache
Nausea / vomiting, diarrhea, or loss of appetite
Feeling unwell for an unknown reason
Have you, or anyone in your immediate family have any of the following : [Fever / chills]
In the last 14 days have you travelled outside of Canada?
Clear selection
Have you had any contact with a confirmed or probable case of COVID-19 or person with acute respiratoryillness (fever, cough, shortness of breath) who has travelled outside of Canada in the last 14 days?
Clear selection
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