Screening Form - Essential Visitors

"*" indicates required fields

Date*
Arrival*
:
Departure*
:
NOTE: When the option of [5, 10] days is listed:
  • Use 5 days if you are fully vaccinated AND/OR 11 years old or younger
  • Use 10 days if you are 12 years old or older and not fully vaccinated OR if you are immunocompromised, OR if you attend or work at a school or student lodging in a highest risk congregate care setting (e.g. a hospital school, or an Education and Community Partnership Program).
Question 1. In the last [5, 10] days have you experienced any of these symptoms?*
Anyone who is sick or has any new or worsening symptoms of illness, including those not listed below, should stay home until their symptoms are improving for 24 hours (or 48 hours for nausea, vomiting, and/or diarrhea) and should seek assessment from their health care provider if needed. You may select "No" to all symptoms if all of these apply:
  • You have completed your isolation of [5/10] days OR you tested negative for COVID-19 on one PCR test or rapid molecular test, or two rapid antigen tests taken 24 to 48 hours apart AND
  • You do not have a fever AND
  • Your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)
Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.

Question 2. In the last [5, 10] days have you experienced any of these symptoms?*
If you only had one of these symptoms, you may select “No” if your symptom has been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).
If you had two or more of these symptoms, you may select “No” if all of these apply:
  • You have completed your isolation of [5/10] days OR you tested negative for COVID-19 on one PCR test or rapid molecular test, or two rapid antigen tests taken 24 to 48 hours apart AND
  • You do not have a fever AND
  • Your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)
Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.

Question 3. In the last [5, 10] days have you tested positive for COVID-19?*
This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test or home-based self-testing kit. Select “No” if you have already completed your isolation period of [5, 10] days because your symptoms started before your positive test result AND:
  • your symptoms have been improving for 24 hours (48 for nausea, vomiting, and/or diarrhea) AND
  • you do not have a fever

Question 4. Do any of the following apply?*
  • You live with someone who is currently isolating because of a positive COVID-19 test
  • You live with someone who is currently isolating because of COVID-19 symptoms (any one or more symptoms from question 1 above or any two or more symptoms from question 2 above)
  • You live with someone who is isolating while waiting for COVID-19 test results
Select “No” if you:
  • are 18 years of age or older and have received your booster OR
  • are 17 years of age or younger and are fully vaccinated OR
  • completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test).
Select “No” if your 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.

Question 5. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?*
This can be because of an outbreak or contact tracing.

Question 6. Do any of the following apply?*
  • In the last 14 days, you travelled outside of Canada and were told to quarantine.
  • In the last 14 days, you travelled outside of Canada and were told to not attend school/child care.

Results of screening questions

If you answered “YES” to ANY question, you cannot go to school or child care. Contact your school/child care provider to let them know that you will not be attending school today. See below for isolation and testing requirements.

NOTE: When the option of [5, 10] days is listed:

  • Use 5 days if you are fully vaccinated AND/OR 11 years old or younger
  • Use 10 days if you are 12 years old or older and not fully vaccinated OR if you are immunocompromised, OR if you attend or work at a school or student lodging in a highest risk congregate care setting (e.g. a hospital school, or an Education and Community Partnership Program).

 

If you answered “YES” to any of the symptoms listed under question 1, do not go to school or child care.

  • You must isolate (stay home) and not leave except to get tested, to get a clinical assessment, or for a medical emergency.
  • If you are not tested, you must isolate for [5, 10] days from when symptoms started and stay in isolation until your symptoms have been improving for 24 hours (or 48 hours after nausea, vomiting and/or diarrhea symptoms), and you do not have a fever, whichever is longest.
    • When determining your isolation period, the day your symptoms began is day 0. For example, for those isolating 5 days, if you develop symptoms on Saturday (day 0), you can return to school on Friday (day 6).
    • If your isolation period is 5 days, from days 6 to 10 after developing symptoms, do not visit or attend work in any highest risk settings (unless you have tested positive for COVID-19 in the past 90 days and have already completed your isolation); continue to wear a well-fitted mask in all public settings (including school and child care); avoid activities where you need to take 4 off your mask (for example, playing a wind instrument in music class or removing your mask for sports); and do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).
  • If testing is available:
    • If a single PCR test, rapid molecular test, or rapid antigen test is positive, you should follow the guidance above for “if you are not tested” and isolate for [5, 10] days.
    • If a single PCR or rapid molecular test is negative or two rapid antigen tests collected 24-48 hours apart are both negative, you may return to school/child care when your symptom(s) have been improving for at least 24 hours (48 hours for nausea, vomiting and/or diarrhea) and you do not have a fever.
  • Household members must stay home at the same time as you, unless they are 17 or younger and fully vaccinated, 18 or older and have received their COVID-19 booster dose AND/OR they have previously tested positive for COVID-19 on a rapid antigen test or molecular test (PCR or rapid molecular) in the past 90 days and have already completed their isolation.
    • Household members isolating because of symptoms and/or a positive test result do not need to extend their isolation period if another household member develops symptoms or tests positive.
    • For 10 days after their last exposure to the person with COVID-19 symptoms, household members: * do not visit or attend work in any highest risk settings (unless they have tested positive for COVID-19 in the past 90 days and have already completed their isolation) * continue to wear a well-fitted mask in all public settings (including school and child care) * avoid activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports) * do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).

 

If you answered “YES” to any of the symptoms listed under question 2, do not go to school or child care.

  • If you have experienced only one of these symptoms in the last [5, 10] days you must stay home until the symptom has been improving for at least 24 hours (48 hours for nausea, vomiting and/or diarrhea). A negative test result is not required for return to school/child care.
    • If you have been identified as a “close contact” of someone with COVID-19 in the last 10 days, even if you are fully vaccinated and the contact was not living with you, it is more likely that you have a COVID-19 infection. You must isolate for [5, 10] days and until you do not have a fever and your symptoms have been improving for at least 24 hours (48 hours for nausea, vomiting, and/or diarrhea).
    • Household members are not required to isolate as long as they do not develop symptoms.
  • If you have experienced two or more of these symptoms in the last [5, 10] days you must isolate (stay home). Follow the instructions under “If you answered “YES” to any of the symptoms listed under question 1, do not go to school or child care.”

 

If you answered “YES” to question 3, do not go to school or child care.

  • You must isolate (stay home) and only leave for a medical emergency or for clinical assessment.
  • You must isolate for [5, 10] days from when symptoms started or from when you tested positive for COVID-19 (whichever was first) and stay in isolation until your symptoms have been improving for 24 hours (or 48 hours after nausea, vomiting and/or diarrhea symptoms) and you do not have a fever, whichever is longest.
    • When determining your isolation period, the day your symptoms started or you tested positive is day 0. For example, for those isolating 5 days, if you develop symptoms or test positive on Saturday (day 0), you can return to school on Friday (day 6).
    • If your isolation period is 5 days, from days 6 to 10 after testing positive or developing symptoms: do not visit or attend work in any highest risk settings; continue to wear a well-fitted mask in all public settings (including school and child care); avoid activities where you need 5 to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports); and do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).
  • Household members must stay home at the same time as you, unless they are 17 or younger and fully vaccinated, 18 or older and have received their COVID-19 booster dose AND/OR they have previously tested positive for COVID-19 on a rapid antigen test or molecular test (PCR or rapid molecular) in the past 90 days and have already completed their isolation.
    • Household members isolating because of symptoms and/or a positive test result do not need to extend their isolation period if another household member develops symptoms or tests positive.
    • For 10 days after their last exposure to the person with COVID-19 symptoms or a positive test result, household members: * do not visit or attend work in any highest risk settings (unless they have tested positive for COVID-19 in the past 90 days and have already completed their isolation) * continue to wear a well-fitted mask in all public settings (including school and child care) * avoid activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports) * do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).

If you answered “YES” to question 4, do not go to school or child care.

  • You must isolate (stay home) while there is anyone in the home who is isolating because of symptoms of COVID-19, a positive COVID-19 test result, or is isolating while waiting for a COVID-19 test result. You should only leave home for a medical emergency or clinical assessment.
  • All household members must stay home at the same time as the household member who has COVID-19 symptoms or is a positive COVID-19 case, unless they are 17 or younger and fully vaccinated, 18 or older and have received their COVID-19 booster dose AND/OR they have previously tested positive for COVID-19 on a rapid antigen test or molecular test (PCR or rapid molecular) in the past 90 days and have already completed their isolation
    • For 10 days after their last exposure to the person with COVID-19 symptoms or a positive test result, household members: * do not visit or attend work in any highest risk settings (unless they have tested positive for COVID-19 in the past 90 days and have already completed their isolation) * continue to wear a well-fitted mask in all public settings (including school and child care) * avoid activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports) * do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).
  • If another household member develops symptoms or tests positive, you must continue isolating until they have also finished their own isolation period. The initial household member(s) with symptoms and/or positive test results does not have to extend their isolation period based on other household members developing symptoms or testing positive.

If you answered “YES” to question 5, do not go to school or child care.

  • You must isolate (stay home) for [5, 10] days and not leave except to get tested, to get a clinical assessment, or for a medical emergency. ϕ
  • When determining your isolation period, the day you were exposed to an individual with symptoms or COVID-19 is day 0. For example, for those isolating 5 days, if you were exposed on Saturday (day 0), you can return to school/child care on Friday (day 6).
    • If your isolation period is 5 days, from days 6 to 10 do not visit or attend work in any highest risk settings (unless you have tested positive for COVID-19 in the past 90 days and have already completed your isolation); continue to wear a well-fitted mask in all public settings (including school and child care); avoid activities where you need to take off your mask (for 6 example, playing a wind instrument in music class or removing your mask for sports); and do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).
  • As long as you and your household members do not develop any symptoms, they do not need to isolate but should self-monitor for symptoms.

If you answered “YES” to question 6, do not go to school or child care.

  • You must follow federal guidelines for individuals who have travelled outside of Canada.

If you have been directed to quarantine you must stay home for 14 days and not leave except to get tested, to get a clinical assessment, or for a medical emergency. For more information on federal requirements for travellers, please see the Government of Canada’s website.

If you develop symptoms, you must also follow isolation guidance found under the results to “If you answered “YES” to any of the symptoms listed under question 1 do not go to school or child care.” and/or “If you answered “YES” to any of the symptoms listed under question 2, do not go to school or child care.”

If you answered “NO” to all questions, you may go to school/child care.

  • As per regular protocols, all sick individuals with any symptoms of illness should stay home and seek assessment from their regular health care provider if required.
  • Individuals with severe symptoms requiring emergency care should go to their nearest emergency department.
  • If you got a COVID-19 vaccine or flu shot in the last 48 hours and are experiencing mild fatigue/ tiredness, muscle aches, and/or joint pain that only began after vaccination, you should wear a properly fitted mask for the entire time at school/child care while you are experiencing these symptoms that only began after vaccination. You may take the mask off to quickly eat or drink and you must stay at least two metres away from others while it is off. If your symptoms worsen, continue past 48 hours, or if you develop other symptoms: you should leave school/child care immediately to isolate.
  • If you travelled outside of Canada in the last 14 days you must follow federal guidelines, even if you were not required to quarantine.
  • Follow the guidance below if you do not have symptoms of COVID-19 and within the last 10 days:
    • You were identified as a close contact of someone with symptoms or with COVID-19 OR
    • You have completed a required 5 days isolation period due to symptoms or testing positive for COVID-19
  • For 10 days after your last exposure to the COVID-19 positive person/person with COVID-19 symptoms, or for days 6 to 10 following the completion of your 5-day isolation period, do not visit or attend work in any highest risk settings (unless you have tested positive for COVID-19 in the past 90 days and have already completed your isolation); continue to wear a well-fitted mask in all public settings (including school and child care); avoid activities where you need to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports); and do not visit anyone who may be at higher risk of illness (for example, seniors or people who are immunocompromised).

Note: The removal of provincial requirements does not mean that the risk for COVID-19 has disappeared. We still need to do our part to protect ourselves and others from COVID-19. This includes practicing good hand hygiene and wearing a mask when required.