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COVID SCREENING TEST
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COVID SCREENING TEST
Students, child care attendees, staff and essential visitors must screen for COVID-19 each day before going to school or child care. Parents/guardians can fill this out on behalf of their child.
Are you filling out this form for yourself or your child?
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Myself
My Child
Full Name
Email *
Are you fully vaccinated against COVID-19 and/or aged 11 or younger?
Yes
No
Do any of the following international travel scenarios apply to you? Please tick all that apply.
In the last 14 days, you travelled outside of Canada and were told to quarantine
In the last 14 days, you travelled outside of Canada and told to not attend school/child care
In the last 14 days, someone you live with returned from outside Canada and is isolating while waiting for COVID-19 test results
None of the above
In the last 5 days, have you experienced any of these symptoms? Please tick any/all that apply?
Fever and/or chills
Cough or barking cough (croup)
Shortness of breath
Decrease or loss of taste or smell
Muscle aches/joint pain
Extreme tiredness
Sore throat
Runny or stuffy/congested nose
Headache
Nausea, vomiting, and/or diarrhea
None of the above
In the last 5 days, have you tested positive for COVID-19?
Yes
No
Do any of the following apply?
You live with someone who is currently isolating because of a positive COVID-19 test.
You live with someone who is currently isolating because of COVID-19 symptoms.
You live with someone who is waiting for COVID-19 test results.
None of the above apply
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
Yes
No
What is your current temperature?
