Students and children must screen for COVID-19 every day before going to school or child care. Parents/guardians can fill this out on behalf of a child. 1. Are they currently experiencing any of these symptoms? Fever and/or chills YesNo Cough or barking cough (croup) YesNo Shortness of breath YesNo Decrease or loss of smell or taste YesNo 2. Are they currently experiencing any of these symptoms? Sore throat or difficulty swallowing YesNo Runny or stuffy/congested nose YesNo Headache that’s unusual or long lasting YesNo Nausea, vomiting and/or diarrhea YesNo Extreme tiredness that is unusual or muscle aches YesNo 3. Have they travelled outside of Canada in the last 14 days? YesNo 4. In the last 14 days, has a public health unit identified them as a close contact of someone who currently has COVID-19? YesNo 5. Has a doctor, health care provider, or public health unit told them/you that they should currently be isolating (staying at home)? YesNo 6. In the last 14 days, have they received a COVID Alert exposure notification on their cell phone? YesNo Thanks for completing the screening form! If any symptoms appear that could change your answer to any of the questions over the course of the day, please inform us immediately. Stop! You are a potential risk for COVID-19. Do not enter the workplace and return home to self-isolate immediately. Contact your healthcare provider or Telehealth Ontario at +1 866-797-0000 to determine if you require a COVID-19 test.