Essential Visitor Screening Form

Adapted from the Ministry of Health and the Ministry of Education

Close Contact Flow Chart Symptoms Flow Chart

"*" indicates required fields

Staff, students, children, and visitors should screen every day before going to school or child care. Parent(s)/guardian(s) can fill this out on behalf of a child or student.

Anyone who is feeling sick or has any new or worsening symptoms of illness, including those not listed in this screening tool, should stay home until their symptoms are improving for at least 24 hours (or 48 hours for nausea, vomiting, and/or diarrhea) and seek assessment from their health care provider if needed.

It is strongly recommended that all individuals age 2 or older wear a well-fitted mask in indoor public settings. This includes school and child care due to the additional risk of Respiratory Syncytial Virus (RSV) and influenza.

Children age 2 to 5 should only wear a mask if they are supervised, can safely tolerate masking, and can put their mask on and take it off.

Please select individual being screened is*

Non-Immunocomprised

Immunocompromised

Examples of immune compromise include cancer chemotherapy, untreated HIV infection with CD4 T lymphocyte count less than 200, combined primary immunodeficiency disorder, taking more than 20 mg/day (or equivalent) of prednisone for more than 14 days, and taking other immune suppressive medications. For this screening tool, factors such as old age, diabetes and end-stage renal disease are generally not considered immunocompromised.

Hidden

Please select form category*

Parent/ Guardian

Staff

Essential Visitor

Staff Full Name*

Visitor Full Name*

Parent/Guardian(s) Full Name*

Date*

Mini-Skool Centre Location*

Children entering the Centre*

Child's Full Name

What is the temperature?

Screening questions

For questions 1, 2, and 3, you can choose “No” to all symptoms if both of these apply:

Your symptoms have been improving for at least 24 hours (48 hours if you had nausea,vomiting, and/or diarrhea) and
You do not have a fever.

Screening questions

For questions 1, 2, and 3, you can choose “No” to all symptoms if all three of these apply:

Your symptoms have been improving for at least 24 hours (48 hours if you had nausea,vomiting, and/or diarrhea) and
You do not have a fever and
You tested negative for COVID-19 on 1 PCR test or rapid molecular test or 2 rapid antigen teststaken 24 to 48 hours apart.

1. Do you have any of these symptoms?

Choose any or all that are new, worsening, and not related to other known causes or conditions.

Fever and/or chills*

Yes

Cough*

Not related to other known causes or conditions (for example, chronic obstructive pulmonary disease)

Yes

Shortness of breath*

Not related to other known causes or conditions (for example, asthma, chronic obstructive pulmonary disease, chronic heart failure)

Yes

Decrease or loss of taste or smell*

Not related to other known causes or conditions (for example, nasal polyps, allergies, neurological disorders)

Yes

If you answered NO to all, skip to the next question. If you answered YES to any of the symptoms in question 1, do not go to school or child care and:

Stay home (self-isolate) and do not attend school/child care 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). Do not leave except to get tested, to visit a clinical assessment centre, or for a medical emergency. If you have severe symptoms like chest pain or difficulty breathing, go to the nearest emergency department.
If COVID-19 testing is available and you are at higher risk of severe illness, you should get tested with 1 PCR or rapid molecular test (if eligible) or 2 rapid antigen tests taken 24 to 48 hours apart (the second test is not needed if the first one is positive).
If you are at higher risk of severe illness, you should get tested as soon as possible given the time frame for receiving COVID-19 treatment. You may benefit from available therapies to prevent severe illness. At this time, a positive rapid antigen test result is sufficient to initiate COVID-19 treatment, for those who are eligible, and does not need to be confirmed by a PCR or rapid molecular test. Learn more about COVID-19 testing and treatment options at https://covid-19.ontario.ca/covid-19-clinical-assessments-and-testing.
Additional precautions for 10 days after your symptoms started:
- wear a well-fitted mask in all public settings (including school and child care)
- avoid non-essential activities where you need to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports; dining out)
- avoid visiting anyone who is immunocompromised or may be at higher risk of illness (for example, seniors)
- avoid non-essential visits to highest risk settings such as hospitals and long-term care homes

Note: For those with negative COVID-19 test results, these additional precautions can be an added layer of prevention against the spread of COVID-19 and other respiratory viruses circulating in the community.

Siblings and other people you live with should do the following for 10 days after their last exposure to the person with COVID-19 symptoms:
- self-monitor for symptoms. They should self-isolate immediately if they develop any symptom of COVID-19 and seek testing if eligible
- wear a well-fitted mask in all public settings (including school and child care)
- avoid non-essential activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports; dining out)
- avoid non-essential visits to anyone who is immunocompromised or who may be at higher risk of illness (for example, seniors)
- avoid non-essential visits to highest risk settings such as hospitals and long-term care homes

Note: Regardless of any COVID-19 test results, these measures can be an added layer of prevention against the spread of COVID-19 and other respiratory viruses circulating in the community.

You do not need to review the remaining questions in this tool today. Retake the screening tool each day before attending school or child care.

If you answered NO to all, skip to the next question.
If you answered YES to any of the symptoms in question 1, do not go to school or child care and:

If COVID-19 testing is available, you are encouraged to get tested with 1 PCR or rapid molecular test (if eligible) or 2 rapid antigen tests taken 24 to 48 hours apart (the second test is not needed if the first one is positive).
If you are at higher risk of severe illness, you should get tested as soon as possible given the time frame for receiving COVID-19 treatment. You may benefit from available treatment to prevent severe illness. At this time, a positive rapid antigen test result is sufficient to initiate COVID-19 treatment, for those who are eligible, and does not need to be confirmed by a PCR or rapid molecular test. Learn more about COVID-19 testing and treatment options at https://covid-19.ontario.ca/covid-19-clinical-assessments-and-testing.
If COVID-19 testing was available and you had a negative result from 1 PCR test or rapid molecular test, or from 2 rapid antigen tests taken 24 to 48 hours apart, you can return to school/child care if it has been at least 24 hours since your symptoms started improving (or 48 hours if you had nausea, vomiting, and/or diarrhea) and you do not have a fever.
- For 10 days after your symptoms started, the following measures can be an added layer of prevention against the spread of other respiratory viruses circulating in the community:
  - wear a well-fitted mask in all public settings (including school and child care)
  - avoid non-essential activities where you need to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports; dining out)
  - avoid visiting anyone who is immunocompromised or may be at higher risk of illness (for example, seniors)
  - avoid non-essential visits to highest risk settings such as hospitals and long-term care homes
If you do not get tested for COVID-19 or if you test positive for COVID-19, stay home (self-isolate) and do not attend school or child care for at least 10 days and until you also do not have a fever and your symptoms have been improving for at least 24 hours (48 hours for nausea, vomiting, and/or diarrhea). Do not leave except to get tested, to visit a clinical assessment centre, or for a medical emergency. If you have severe symptoms like chest pain or difficulty breathing, go to the nearest emergency department.
- Please note that if you tested positive for COVID-19, you should isolate for 10 days regardless of whether you later test negative within your isolation

Note: The duration of isolation may be modified based on your health care provider’s direction.

Siblings and other people you live with should do the following for 10 days after their last exposure to the person with COVID-19 symptoms:
- self-monitor for symptoms. They should self-isolate immediately if they develop any symptom of COVID-19 and seek testing if eligible
- wear a well-fitted mask in all public settings (including school and child care)
- avoid non-essential activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports, dining out)
- avoid non-essential visits to anyone who is immunocompromised or who may be at higher risk of illness (for example, seniors)
- avoid non-essential visits to highest risk settings such as hospitals and long-term care homes

Regardless of negative COVID-19 test results, these measures can be an added layer of prevention against the spread of COVID-19 and other respiratory viruses circulating in the community.

You do not need to review the remaining questions in this tool today. Retake the screening tool each day before attending school or child care.

2. Do you have any of these symptoms?

Choose any or all that are new, worsening, and not related to other known causes or conditions you already have.

Muscle aches or joint pain*

Not related to other known causes or conditions (for example, getting a COVID-19 vaccine and/or flu shot in the last 48 hours, osteoarthritis, fibromyalgia)

Yes

Extreme tiredness*

General feeling of being unwell, lack of energy, not related to other known causes or conditions (for example, getting a COVID-19 vaccine and/or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, anemia, malignancy)

Yes

Sore throat*

Painful swallowing or difficulty swallowing, not related toother known causes or conditions (for example, post-nasal drip, acid reflux)

Yes

Runny or stuffy/congested nose*

Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather, chronic sinusitis)

Yes

Headache*

Not related to other known causes or conditions (for example, getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines)

Yes

Nausea, vomiting and/or diarrhea*

Not related to other known causes or conditions (for example, transient vomiting due to anxiety in children, chronic vestibular dysfunction, irritable bowel syndrome, inflammatory bowel disease, side effects of medication)

Yes

If you answered NO to all, skip to the next question.
If you answered YES to two or more of the symptoms in question 2, follow the guidance under “if you said YES to any symptoms in question 1.”
If you answered YES to only one symptom under question 2, do not go to school or child care and:

Stay home until your symptom(s) have been improving for at least 24 hours (or 48 hours if you had nausea, vomiting, or diarrhea) and as long as you do not have a fever.
Siblings or other people you live with do not need to stay home as long as they do not develop symptoms.
You do not need to review the remaining questions in this tool today. Retake the screening tool each day before attending school or child care.

3. Do you have any of these symptoms?

Choose any or all that are new, worsening, and not related to other known causes or conditions you already have.

Abdominal pain*

Not related to other known causes or conditions (for example, menstrual cramps, gastroesophageal reflux disease)

Yes

Pink eye*

Not related to other known causes or conditions (for example, blepharitis, recurrent styes)

Yes

Decreased or no appetite (young children only)*

Not related to other known causes or conditions (for example, anxiety, constipation)

Yes

If you answered NO to all, skip to the next question.
If you answered YES to any symptoms under question 3, do not go to school or child care and:

Stay home until your symptom(s) have been improving for at least 24 hours.
Siblings or other people you live with do not need to stay home as long as they do not develop symptoms.
You do not need to review the remaining questions in this tool today. Retake the screening tool each day before attending school or child care.

4. Have you been told you that you should currently be quarantining, isolating, staying at home, or not attending school or child care?*

Yes

This could include being told by a doctor, health care provider, public health unit, federal border agent, or other government authority.
Please note there are federal requirements (https://travel.gc.ca/travel-covid) for individuals who travelled outside of Canada, even if exempt from quarantine.

If you answered NO, skip to the next question.
If you answered YES to question 4, do not go to school or child care and:

Stay home and do not leave except to get tested, to visit a clinical assessment centre, or for a medical emergency.
Follow any other guidance or directions that have been provided to you
Siblings and other people you live with do not have to stay home unless they were also told to quarantine, isolate, or stay home.
You do not need to review the remaining questions in this tool today. Retake the screening tool each day before attending school or child care.

5. In the last 10 days have you tested positive for COVID-19?*

Yes

This includes a positive COVID-19 test result on a laboratory-based PCR test, rapid molecular test, rapid antigen test or other home-based self-testing kit.

If you answered NO, skip to the section below “If you answered ‘no’ to all questions.”
If you answered YES to question 5, and you do not have any new or worsening symptoms, you may go to school or child care

If you have or develop any new or worsening symptoms, stay home until you have no fever and your symptoms have been improving for at least 24 hours (or 48 hours if you had nausea, vomiting, or diarrhea).
For 10 days after you tested positive for COVID-19 (or from when symptoms started, whichever came first):
- wear a well-fitted mask in all public settings (including school and child care)
- avoid non-essential activities where you need to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports; dining out)
- avoid visiting anyone who is immunocompromised or may be at higher risk of illness (for example, seniors)
- avoid non-essential visits to highest risk settings such as hospitals and long-term care homes.

Note: If you tested positive in the last 10 days, you should still follow these instructions even if you later test negative.

Siblings and other people you live with should do the following for 10 days after their last exposure to the person who tested positive:
- self-monitor for symptoms. They should self-isolate immediately if they develop any symptom of COVID-19 and seek testing if eligible
- wear a well-fitted mask in all public settings (including school and child care)
- avoid non-essential activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports; dining out)
- avoid non-essential visits to anyone who is immunocompromised or who may be at higher risk of illness (for example, seniors)
- avoid non-essential visits to highest risk settings such as hospitals and long-term care homes

If you answered NO, skip to the section below “If you answered ‘no’ to all questions.”
If you answered YES, do not go to school or child care and:

You should isolate and not attend school/child care for at least 10 days.
If you develop symptoms, do not attend school or child care for at least 10 days and until you also do not have a fever and your symptoms have been improving for at least 24 hours (48 hours for nausea, vomiting, and/or diarrhea). Do not leave except to visit a clinical assessment centre or for a medical emergency.

Note: The duration of isolation may be modified based on your health care provider’s direction.

If you are at higher risk of severe illness, contact your healthcare provider as you may be eligible for COVID-19 treatment.
Siblings and other people you live with should do the following for 10 days after their last exposure to the person who tested positive for COVID-19:
- self-monitor for symptoms. They should self-isolate immediately if they develop any symptom of COVID-19 and seek testing if eligible
- wear a well-fitted mask in all public settings (including school and child care)
- avoid non-essential activities where they need to take off their mask (for example, playing a wind instrument in music class or removing their mask for sports; dining out)
- avoid non-essential visits to anyone who is immunocompromised or who may be at higher risk of illness (for example, seniors)
- avoid non-essential visits to highest risk settings such as hospitals and long-term care homes

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

If you feel sick or not well, even with symptoms not listed in this screening tool, you should stay home. Talk with a doctor if necessary. Individuals with severe symptoms requiring emergency care should go to their nearest emergency department.
Retake this screening every day before going to school/child care.

If you were identified as a close contact of someone with symptoms or with COVID-19, for 10 days after your last exposure to the person:

wear a well-fitted mask in all public settings (including school and child care)
avoid non-essential activities where you need to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports)
avoid non-essential visits to anyone who is immunocompromised or at higher risk of illness (e.g., seniors) •
avoid non-essential visits to highest risk settings such as hospitals and long-term care homes.

Note: Regardless of negative COVID-19 test results, these measures can be an added layer of prevention against the spread of COVID-19 and other respiratory viruses circulating in the community.

If you had symptoms of COVID-19 in the last 10 days, for 10 days after the symptoms started:

wear a well-fitted mask in all public settings (including school and child care)
avoid non-essential activities where you need to take off your mask (for example, playing a wind instrument in music class or removing your mask for sports; dining out)
avoid visiting anyone who is immunocompromised or may be at higher risk of illness (for example, seniors)
avoid non-essential visits to highest risk settings such as hospitals and long-term care homes

Note: For those with negative COVID-19 test results, these measures can be an added layer of prevention against the spread of COVID-19 and other respiratory viruses circulating in the community.

If you got a COVID-19 vaccine or flu shot in the last 48 hours and you have mild fatigue, muscle aches/joint pain, and/or headache:

You cannot develop an infection from either the COVID-19 vaccine or flu shot. Some people do experience flu-like symptoms after vaccination. If you are experiencing mild fatigue or tiredness, muscle aches and/or join paint that only started after vaccination, you should wear a well-fitted mask the entire time you are at school or child care as an added precaution until you are symptom-free.
If your symptoms worsen or continue past 48 hours after your vaccine, or if you develop other symptoms (e.g. sore throat, loss of taste or smell, shortness of breath, cough), you should leave school or child care immediately

If you got a COVID-19 vaccine or flu shot in the last 48 hours and you have mild fatigue, muscle aches/joint pain, and/or headache:

You cannot develop an infection from either the COVID-19 vaccine or flu shot. Some people do experience flu-like symptoms after vaccination. If you are experiencing mild fatigue or tiredness, muscle aches and/or join paint that only started after vaccination, you should wear a well-fitted mask the entire time you are at school or child care as an added precaution until you are symptom-free.
If your symptoms worsen or continue past 48 hours after your vaccine, or if you develop other symptoms (e.g. sore throat, loss of taste or smell, shortness of breath, cough), you should leave school or child care immediately.

If you have travelled outside of Canada in the last 14 days

You must follow any federal guidelines (https://travel.gc.ca/travel-covid) after returning to Canada, even if you were not required to quarantine.

Wear a mask in indoor public settings

It is strongly recommended that all individuals age 2 or older wear a well-fitted mask in indoor public settings. This includes school and child care due to the additional risk of Respiratory Syncytial Virus (RSV) and influenza.
Children age 2 to 5 should only wear a mask if they are supervised, can safely tolerate masking, and can put their mask on and take it off.

Additional health and safety tips
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, frequently cleaning and disinfecting high-touch surfaces, and wearing a mask where recommended or required.

Get the COVID-19 vaccine and other routine immunizations when eligible.
Vaccines are safe, effective, and the best way to protect you and those around you from infectious diseases. Learn more at: https://www.ontario.ca/page/vaccines

Essential Visitor Screening Form

Adapted from the Ministry of Health and the Ministry of Education

1. Do you have any of these symptoms?

2. Do you have any of these symptoms?

3. Do you have any of these symptoms?

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