COVID-19 Pre-Screening Form

Your Name (must be legal parent/guardian of participant)

Participant Name

1. Does the child live and/or go to school/child care in Toronto or Peel Region?

YesNo

2. Is the child currently experiencing any of these symptoms?

Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higherCough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have)Shortness of breath - Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have)Decrease or loss of smell or taste - Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already haveSore throat or difficulty swallowing - Painful swallowing (not related to seasonal allergies, acid reflux, or other known causes or conditions they already have)Runny or stuffy/congested nose - Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions they already haveHeadache - Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions they already have)Nausea, vomiting and/or diarrhea - Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already haveExtreme tiredness or muscle aches - Unusual, fatigue, lack of energy, poor feeding in infants (not related to depression, insomnia, thyroid disfunction, sudden injury, or other known causes or conditions they already have)None of the above

3. In the last 14 days, has the child travelled outside of Canada?

YesNo

4. In the last 14 days, has the student/child been identified as a close contact of someone who currently has COVID-19?

YesNo

5. Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)?

YesNo

6. In the last 14 days, has the child received a COVID Alert exposure notification on their cell phone? (If they already went for a test and got a negative result, select No.)

YesNo

7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

YesNo

Results of Screening Questions

If you answered YES to question 1 (living in Toronto or Peel Region) and the child
has any of the symptoms included under question 2 do not go to the studio.

• The student/child should isolate (stay home) and not leave except to get tested or for a
  medical emergency
• Talk with a doctor/health care provider to get advice or an assessment, including if they need
  a COVID-19 test
• Check with your school/child care provider or your local public health unit to see if siblings or
  other people in your household without symptoms should isolate and for how many days. The rules are different in certain parts of the province because of local risk factors.
• Contact your school/child care provider to let them know about this result

If you answered YES to two or more of the symptoms included under question 2, or to having
fever and/or chills, cough or barking cough, shortness of breath, decrease or loss of taste or
smell do not go to school or child care.

• The student/child should isolate (stay home) and not leave except to get tested or for a
  medical emergency
• Talk with a doctor/health care provider to get advice or an assessment, including if they need
  a COVID-19 test
• Check with your school/child care provider or your local public health unit to see if siblings or
  other people in your household without symptoms should isolate and for how many days. The rules are different in certain parts of the province because of local risk factors.
• Contact your school/child care provider to let them know about this result

If you answered YES to having only one of sore throat/difficulty swallowing, runny/stuffy/
congested nose, headache, nausea, vomiting/diarrhea, extreme tiredness/muscle aches
do not go to school or child care.

• The student/child should isolate (stay home) for 24 hours and not leave except for a medical
  emergency.
• Talk with a doctor/health care provider to get advice or an assessment, including if they need
  a COVID-19 test.
• After 24 hours:
  • If their symptom is improving, they can return to school/child care when they feel well
    enough to go. They do not need to get tested.
  • If their symptom is persisting, worsening, or they are developing new symptoms, continue to stay home and talk with a doctor/health care provider for more advice, including if they need a COVID-19 test.
• Check with your school/child care provider or your local public health unit to see if siblings or
  other people in your household without symptoms should isolate and for how many days. The rules are different in certain parts of the province because of local risk factors.
• Contact your school/child care and let them know about this result.

If you answered YES to question 3 or 4 do not go to school or child care.

• The student/child should self-isolate (stay home) for 14 days and not leave except to get tested
  or for a medical emergency.
• Follow the advice of public health. They can return to school/child care after they are cleared
  by your local public health unit.
• If they develop symptoms, contact your local public health unit or doctor/health care provider
  for more advice.
• Check with your school/child care provider or your local public health unit to see if siblings or
  other people in your household should isolate and for how many days. The rules are different
  in certain parts of the province because of local risk factors.
• Contact your school/child care provider to let them know about this result.

If you answered YES to question 5 or 6 do not go to school or child care.

• The student/child should self-isolate (stay home) and not leave except to get tested or for a
  medical emergency.
• If you answered YES to question 5, visit an assessment centre to get them a COVID-19 test.
  • If they test negative (they do not have the virus), they can return to school/child care.
  • If they test positive (they have the virus), they can return only after they are cleared by your local public health unit.
• If you answered YES to question 6, follow the advice of public health. They can return to
  school/child care after they are cleared by your local public health unit.
  • If they develop symptoms, contact your local public health unit or doctor/health care provider for more advice.
• Check with your school/child care provider or your local public health unit to see if siblings or
  other people in your household should isolate and for how many days. The rules are different
  in certain parts of the province because of local risk factors.

If you answered NO and None of the above to all the questions, your child may come to the studio!