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* 2. Your Information

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* 3. Today's Date

Date

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* 4. Temp Check: (must be below 37.8 degrees Celsius)

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* 5. Does your child have any new or worsening *fever/chills *cough or barking cough (croup)*shortness of breath *decreased or loss of smell or taste *nausea, vomiting and/ or diarrhea Not related to irritable bowel syndrome, anxiety, menstrual cramps or other known causes or conditions.

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* 6. Do any of the following apply to the student/child?

*They are fully vaccinated against COVID-19 (it has been 14 days or more since their final dose of either a two-dose or a one-dose vaccine series)

*They have tested positive for COVID 19 in the last 90 days (and since been cleared)

If YES, skip questions 3,4,5

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* 7. Is someone that the student/child lives with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

 Children: fever and or chills, cough or barking cough, shortness of breath, decrease or loss of taste or smell, nausea, vomiting and or diarrhea

Adults over 18: fever and or chills, cough or barking cough, shortness of breath, decrease or loss of taste or smell, tiredness, muscle aches

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* 8. In the last 10 days, has the student/child been identified as a “close-contact” of someone who currently has COVID-19?

If public health has advised you that you do not need to self-isolate, select “No” 

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* 9. In the last 10 days, has the student /child received a COVID Alert exposure notification on their cell phone?

*If the student/child has since tested negative on a lab-based PCR test, select “NO” 

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* 10. Do any of the following supply?

*In the last 14 days, the student/child travelled outside of Canada and was told to quarantine

*In the last 14 days, the student/child travelled outside of Canada and was told to not attend school/child care

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* 11. Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)?

This can be because of an outbreak or contact tracing

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* 12. In the last 10 days, have you /your child tested positive on a rapid antigen test or a home-based self-testing kit?

If the student/child has since tested negative on a lab based PCR test, select ‘NO” 

0 of 12 answered
 

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