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Home
Register Now
About
Emergent Curriculum
Specialty Programs
Locations
COVID Resources
Child Screening Form
Visitor Screening Form
Staff Screening Form
Contact
Join Our Team
Visitor Online Screening Form
Visitor Screening
Visitor Information
First Name
*
Last Name
*
Phone
*
Campus
*
Main
South
Giles
West
Coronation
Reason For Entering
*
Screening Questions - Section 1
Are you currently experiencing any of these symptoms? Choose any/all that are new,
worsening, and not related to other known causes or medical conditions.
Fever and/or chills
(temperature of 37.8°C/100.0°F or greater)
*
Yes
No
Cough or barking cough (croup) Continuous, more than usual, making a whistling noise when breathing, not related to other known causes or conditions (for example, asthma, post- infectious reactive airways)
*
Yes
No
Shortness of breath Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma)
*
Yes
No
Sore throat Not related to other known causes or conditions (for example, seasonal allergies, acid reflux)
*
Yes
No
Difficulty swallowing Painful swallowing, not related to other known causes or conditions
*
Yes
No
Runny or stuffy/congested nose Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather)
*
Yes
No
Pink eye Conjunctivitis, not related to other known causes or conditions (for example, reoccurring styes)
*
Yes
No
Headache that’s unusual or long lasting Not related to other known causes or conditions (for example, tension-type headaches, chronic migraines)
*
Yes
No
Digestive issues like nausea/vomiting, diarrhea, stomach pain Not related to other known causes or conditions (for example, irritable bowel syndrome, menstrual cramps)
*
Yes
No
Muscle aches that are unusual or long lasting Not related to other known causes or conditions (for example, a sudden injury, fibromyalgia)
*
Yes
No
Extreme tiredness that is unusual Fatigue, lack of energy, not related to other known causes or conditions (for example, depression, insomnia, thyroid disfunction)
*
Yes
No
Falling down often For older people
*
Yes
No
Additional Screening Questions
2. Have you travelled outside of Canada in the last 14 days?
*
Yes
No
3. In the last 14 days, has a public health unit identified you as a close contact of someone who currently has COVID-19?
*
Yes
No
4. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
*
Yes
No
5. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
*
Yes
No
If you already went for a test and got a negative result, select “No.”
These Instructions show if you answered “YES” to any of the symptoms included under question 1:
• Contact the school/child care to let them know about this result.
• You should isolate (stay home) and not leave except to get tested or for a medical emergency.
• Talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test.
• Household members without symptoms may go to school/child care/work. Check your local public health unit’s website or call to see if they have different rules based on local risk.
These Instructions show if you answered “YES” to question 2 or 4:
• Contact the school/child care to let them know about this result.
• You should isolate (stay home) for 14 days and not leave except to get tested or for a medical emergency.
• Follow the advice of public health. You can return to school/child care only after you are cleared by your local public health unit.
• Household members without symptoms may go to school/child care/work. Check your local public health unit’s website or call to see if they have different rules based on local risk.
These Instructions show if you answered “YES” to question 3:
• Contact the school/child care to let them know about this result.
• You should isolate (stay home) for 14 days and not leave except to get tested or for a medical emergency.
• Talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test. You can return to school/child care only when you are cleared by your local public health unit, regardless of test result.
These Instructions show if you answered “YES” to question 5:
• Contact the school/child care to let them know about this result.
• You should isolate (stay home) for 14 days and not leave except to get tested or for a medical emergency.
• Visit an assessment centre to get a COVID-19 test. Talk with a doctor/health care provider for more advice.
If you answered “NO” to all questions, you may go to school/child care.
By checking the box below, I hereby declare that:
The information provided is to the best of my knowledge accurate, truthful
& correct in all respects, and I have not omitted to disclose any information.
*
Submit
If you are human, leave this field blank.
