COVID-19 SCREENING

Please complete before entering the Moving Art Centre

Please complete before entering the Moving Art Centre *If the response to ALL of the screening questions is NO: COVID Screen NEGATIVE (Entry will be permitted) *If the response to ANY of the screening questions is YES: COVID Screen POSITIVE (Entry will be denied)

Name of Student

First Last

Todays Date*

Does your child have any of the following:

Fever*

YES
NO

Cough*

YES
NO

Difficultly Breathing*

YES
NO

Sore throat, trouble swallowing*

YES
NO

Runny nose, red eyes*

YES
NO

Loss of Taste and Smell*

YES
NO

Not feeling well, tired or sore muscles*

YES
NO

Nausea, vomiting or diarrhea*

YES
NO

Has your child been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days?*

YES
NO

Has your child returned from travel outside Canada in the past 14 days?*

YES
NO

Has your child had any fever- reducing medication within the last 24 hours?*

YES
NO

If you answered YES to any of these questions, please go home and self-isolate right away. Call Telehealth or your health care provider, to find out if you need a test.

Parent Name*

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