COVID-19 INFORMATION

GUIDANCE FOR SCHOOL RE-ENTRY – SCENARIO 1
In-school classes resume (near normal with health measures)

Appendix C
Screening Questionnaire
PARENTS/GUARDIANS/STUDENTS MUST USE THIS QUESTIONNAIRE DAILY TO DECIDE IF
THE STUDENT SHOULD ATTEND SCHOOL
Risk Assessment: Initial Screening Questions
1.

2.
3.

Do you, or your child attending the program, have any of the below symptoms:
 Fever
 Cough
 Shortness of Breath / Difficulty Breathing
 Sore throat
 Chills
 Painful swallowing
 Runny Nose / Nasal Congestion
 Feeling unwell / Fatigued
 Nausea / Vomiting / Diarrhea
 Unexplained loss of appetite
 Loss of sense of taste or smell
 Muscle/ Joint aches
 Headache
 Conjunctivitis (Pink Eye)
Has the person attending the activity/facility travelled outside of Canada in the
last 14 days?
?
Have
you/your child had close unprotected* contact (face-to-face contact
within 2 meters/6 feet) with someone who has travelled outside of Canada
in the last 14 days and who is ill**?

4.

Have you/your child attending the program or activity had close
unprotected* contact (face-to-face contact within 2 meters/6 feet) in the last
14 days with someone who is ill**?

5.

Have you/your child or anyone in your household been in close unprotected
contact in the last 14 days with someone who is being investigated or
confirmed to be a case of COVID-19?

CIRCLE ONE
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES

NO

YES

NO

YES

NO

* “unprotected” means close contact without appropriate personal protective equipment (PPE).

If you have answered “Yes” to any of the above questions, please DO NOT enter the school at this time.
You should stay home and use the COVID-19 Self-Assessment Tool to determine whether you need to be
tested for COVID-19.
If you have answered “No” to all the above questions, you may attend school.

©2020 Government of Alberta
Published: July 21, 2020

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