* Required

COVID-19 Screening Form

We request that you complete this screening on the day of your visit and before you arrive to the school.

Please use full company name. No abbreviations please.
Please use full company name. No abbreviations please. ​
Ex. 905-833-1909​
This form must be completed the day of the visit.​​

As you are aware, the best understanding of the present evidence is that COVID-19 can be transmitted by persons who do not exhibit symptoms. There is no guarantee that COVID-19 will not be contracted by persons entering the School premises.

Are you currently experiencing any of these symptoms?

Check the appropriate answer. Choose any/all that are new, worsening and not related to other known causes or conditions you already have.

Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher​
Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways or other known causes or conditions they already have)​
Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have)​
Not related to seasonal allergies, neurological disorders or other known causes or conditions they already have​
Painful swallowing (not related to seasonal allergies, acid reflux or other known causes or conditions they already have)​
Not related to seasonal allergies, being outside in cold weather or other known causes or conditions they already have​
Unusual, long-lasting (not related to tension-type headaches, chronic migraines or other known causes or conditions they already have)​
Not related to irritable bowel syndrome, anxiety, menstrual cramps or other known causes or conditions they already have​
Unusual, fatigue, lack of energy, poor feeding in infants (not related to depression, insomnia, thyroid disfunction, sudden injury or other known causes or conditions they already have)​
Conjunctivitis, not related to other known causes or conditions​
Who is not exempt from self-isolation because they perform an essential job (e.g. truck driver, pilot) and currently live within the home (i.e. they are not isolating at a government-funded isolation centre)​
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