Ontario COVID-19 Daily Screening Checklist (under 18)
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.
Screening Questions (answer YES or NO to all questions)
1. Are they currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions
Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions they already have
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
Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have
2. In the last 14 days, have they travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?
YES NO
3. Has a doctor, health care provider, or public health unit told you that they should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing.
YES NO
4. In the last 10 days, have they been identified as a “close contact” of someone who currently has COVID-19? If public health has advised you that they do not need to self-isolate (e.g., you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been cleared), select “No.”
YES NO
5. In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? If you have already gone for a test and got a negative result, select "No." If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
YES NO
6. . In the last 10 days, have they tested positive on a rapid antigen test or a homebased self-testing kit? If you have since tested negative on a lab-based PCR test, select “No.”
YES NO
7. In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements) in the last 14 days? If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”
YES NO
8. In the last 10 days, has someone in your household (someone you live with) been identified as a ”close contact” of someone who currently has COVID-19 AND advised by a doctor, healthcare provider or public health unit to self-isolate in the last 10 days? If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”
YES NO
9. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”
YES NO
Results of Screening Questions:
• If the patron answered NO to all questions from 1 through 9, they can enter the business or organization. In the business or organization, the patron must continue to follow all public health measures, including masking, maintaining physical distance and hand hygiene, where applicable.
• If the patron answered YES to any questions from 1 through 9, they should not be permitted to enter the business or organization (including any outdoor or partially outdoor business or facility). They should be advised to go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1-866-797- 0000) to get advice or an assessment, including if they need a COVID-19 test.
• If the patron answered YES to question 9, they must be advised to stay home, along with the rest of the household, until the sick individual gets a negative COVID-19 test result, is cleared by their local public health unit, or is diagnosed with another illness. 6 | Page
• If any of the answers to these screening questions change during the day, this screening result is no longer valid and the patron may need to screen again, wherever necessary.
• Any record created as part of patron screening may only be disclosed as required by law.
Please accept all conditions.