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COVID SCREENING CHECKLIST

COVID SCREENING FORM

1. Do you have any of the following symptoms: fever/feverish and or chills, new or existing cough, shortness of breath, sore throat, difficulty swallowing, decrease or loss of smell or taste, runny or stuffy nose, headache, nausea/vomiting, diarrhea, muscle aches/joint aches, extreme tiredness, pink eye, stomach pain, or falling down often?
2. Have you traveled internationally within the last 14 days (outside of Canada)
3. Have you had close contact with a confirmed or probable COVID-19 case?
4. Have you had close contact with a person with an acute respiratory illness who has been outside Canada in the last 14 days?
5. Has anyone you live with experienced COVID-19 symptoms?
6. Have you tested positive for COVID-19 in the last ten days?
7. Has a health care provider or public health unit told you to isolate?
8. Have you been identified as a close contact of someone with COVID-19?
9. Have you received a COVID alert exposure notification and have not been tested or awaiting test results?
10. Who is attending today's lesson?
Time of Lesson
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