BMC COVID-19 Screening Questionnaire
To ensure schools and Division offices are safe for students, teachers and administration, all visitors (including parents) and contractors must complete this questionnaire prior to being permitted into the school.
Email *
Name *
Does the person coming to the school have any of these 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 (commonly known as pink eye)
Has the attendee travelled outside of Canada in the last 14 days? *
Has the attendee had close contact* with a confirmed case of COVID-19in the last 14 days? *
Has the attendee had close contact with a symptomatic** close contactof a confirmed case of COVID-19 in the last 14 days? *
* Face-to-face contact within 2 metres. A health care worker in a occupational setting wearing the recommended personal protective equipment is not considered to be a close contact.
** ‘Ill/symptomatic’ means someone with COVID-19 symptoms on the list abov
A copy of your responses will be emailed to the address you provided.
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