COVID-19 Daily Screening Questionnaire (-18)

Participants must screen for COVID-19 before every class. Parents/guardians can fill this out on behalf of a child.

Screening Questions (answer YES or NO to all questions)

1. In the last 5 days, have they experienced any of these symptoms?

• Fever and/or chills   Temperature of 37.8°C/100°F or higher
• 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)
• Shortness of breath   Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma)
• Decrease or loss of smell or taste   Not related to other known causes or conditions (for example, allergies, neurological disorders)
• Sore throat or difficulty swallowing   Painful swallowing, not related to other known causes or conditions (for example, seasonal allergies, acid reflux)
• Runny or stuffy/congested nose   Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather)
• Pink eye   Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)
• Headache that’s unusual or long lasting   Not related to other known causes or conditions (for example, tension-type headaches, chronic migraines)
• Nausea, vomiting and/or diarrhea   Not related to other known causes or conditions (for example, irritable bowel syndrome, anxiety in children, menstrual cramps)
• Extreme tiredness that is unusual or muscle aches   Fatigue, lack of energy, poor feeding in infants, not related to other known causes or conditions (for example, depression, insomnia, thyroid dysfunction, sudden injury)

Choose YES if any are new, worsening, and not related to other known causes or medical conditions. 
 YES   NO

2. In the last 5 days, has the participant tested positive for COVID-19?  If they have already completed their isolation period of 5 days because their symptoms started before their positive test result AND their symptoms have been improving for 24 hours (48 for nausea, vomiting, and/or diarrhea) AND they do not have a fever, Select “No”. 
 YES   NO 

3. Does the participant live with someone who is currently isolating because of a positive COVID-19 test, COVID-19 symptoms or waiting for COVID-19 test results? If the participant is fully vaccinated, or completed their isolation after testing positive in the last 90 days, or if the household member is isolating because of COVID-19 symptoms but has already tested negative on one PCR or rapid molecular test, or two rapid antigen tests, select “No”. 
 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 they or someone they live with traveled outside of Canada and been told to self-isolate? If the participant is not fully vaccinated**, you must answer yes and they are not to attend for 14 days, even if they traveled with a vaccinated companion. 
 YES   NO

** Fully vaccinated means 14 days or more after a second dose of a COVID-19 vaccine series, or as defined by the Ontario Ministry of Health.

If an individual answers YES to any of the questions, they are not allowed to attend or participate. You should isolate (stay home) and not leave except to get tested or for a medical emergency.  Talk with a doctor/health care provider or call Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if you need a COVID-19 test.