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Daily Screening Form
PLEASE SUBMIT THIS FORM PRIOR TO EVERY VISIT TO THE SCHOOL
Your Name (Last Name, First Name)
Class/Training Date
Are you currently experiencing any of the following symptoms?
Fever (Temperature of 37.8 degrees Celsius or higher)
Chills
New or worsening cough
Shortness of breath or difficulty breathing (not related to another cause such as asthma)
Sore throat
Difficulty swallowing
Runny or stuffy nose (not related to another cause such as allergies)
Nausea, vomiting, diarrhea or stomach pain
Decrease or loss of taste or smell
Unexplained fatigue or muscle aches
Eye pain or pink eye
None of the above
Have you travelled outside of Canada in the last 14 days?
Yes
No
In the last 14 days, have you tested positive for COVID-19 or have you been in contact with any COVID-19 positive persons?
Yes
No
Submit
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