Screening Questionnaire
Staff persons and students must use this questionnaire
daily to decide if they should attend school.

COVID-19

INFORMATION

Parents should complete the screening
on behalf of their school-aged child.

Risk Assessment: Initial Screening Questions

CIRCLE ONE

Do you (staff or student) have 2 or more of the following possible COVID-19
symptoms (new or worsening):
•  Fever (or signs of fever, including chills, sweats, muscle aches, lightheadedness)
•  Cough
•  Sore throat
•  Headache
•  Runny Nose / Nasal Congestion
•  Nausea / Vomiting / Diarrhea / unexplained loss of appetite
•  Loss of sense of taste or smell

YES

NO

•  OR red or purple spots on hands and/or feet

YES

NO

2.

Have you (staff or student) traveled in the last 14 days outside the Atlantic
Provinces (New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland
and Labrador) or outside the communities along the Labrador-Quebec border
(Labrador City, Wabush, Fermont, the Labrador Straits area and Blanc Sablon)?

YES

NO

3.

Have you (staff or student) been in close contact with anyone who has travelled
outside the Atlantic Provinces in the past 14 days who has developed COVID-19
symptoms?

YES

NO

4.

Have you (staff or student) been in close contact with a known or suspected case of
COVID-19 in the last 14 days?

YES

NO

1.

•  If the answer is “Yes” to any of the above questions, please DO NOT enter the school at this time.
The staff member or student should stay home and use the COVID-19 Self-Assessment Tool.
•  If the answers are “No” to all of the above questions, the staff member or student may attend school.
NOTE:  If someone in your house is self-isolating and DOES NOT have COVID-19 symptoms you CAN
attend school.
 

If someone in your house is self-isolating and DOES have COVID-19 symptoms, call 811 and
follow the advice from the public health official.

For more information visit gov.nl.ca/eecd/NLSafeSchools
Last updated September 3, 2020