COVID-19 Self Screening Questionnaire - Student
Parents/Guardians/Students MUST use this questionnaire daily to decide if the student should attend school
Risk Assessment: Initial Screening Questions
Name of Child *
Grade Level of Child *
1) Do you, or your child attending the program, have any of the below symptoms: *
Yes
No
Fever
Cough
Shortness of Breath / Difficulty Breathing
Sore throat
Chills
Painful swallowing
Runny Nose / Nasal Congestion
Feeling unwell / Fatigued
Nausea / Vomiting / Diarrhea
Unexplained loss of appetite
Loss of sense of taste or smell
Muscle / Joint aches
Headache
Conjunctivitis (Pink Eye)
2) Have you, or anyone in your household, returned from travel outside of Canada in the last 14 days? *
3) Have you or your children attending the program had close UNPROTECTED contact (face-to-face contact within 2 metres) with someone who is ill with cough and/or fever? *
4) Have you or anyone in your household been in close UNPROTECTED contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *
* "UNPROTECTED" means close contact without appropriate personal protective equipment (PPE).
If you have answered "YES" to any of the above questions, please DO NOT enter the school at this time. You should stay home and use the COVID-19 Self-Assessment Tool to determine whether you need to be tested for COVID-19.
https://covid-19.ontario.ca/self-assessment/


If you have answered "NO" to all the above questions, you may attend school.
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