Audrey’s Clubhouse Latchkey & E.L.C. has reopened as of September 14th, 2020. Call for a spot.

COVID-19 Screening for Staff and Visitors

    Location:



    Name of person filling out this form:




    Screening Questions

    1. In the last 14 days, have you travelled outside of Canada?

    If exempt from federal quarantine requirements (for example, an essential worker who crosses the Canada-US border regularly for work), select "No."



    2. 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.



    3. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?



    4. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?

    If you already went for a test and got a negative result, select “No.”



    5. Are you currently experiencing any of these symptoms?

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


    Fever and/or chills

    Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher


    Cough or barking cough (croup)

    Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)


    Shortness of breath

    Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)


    Decrease or loss of taste or smell

    Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have


    Sore throat

    Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have


    Difficulty swallowing

    Painful swallowing (not related to other known causes or conditions you already have)


    Runny or stuffy/congested nose

    Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have


    Pink eye

    Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)


    Headache

    Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have)

    If you received a COVID-19 vaccination in the last 48 hours and are experiencing a mild headache that only began after vaccination, select “No.


    Digestive issues like nausea/vomiting, diarrhea, stomach pain

    Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have


    Muscle aches

    Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have)

    If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild muscle aches/joint pain that only began after vaccination, select "No."


    Extreme tiredness

    Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

    If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”


    Falling down often

    For older people


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

    If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.



    Results of Screening Questions

    If you answered “YES” to question 1 or 3 do not go to school or child care.

    • You must isolate (stay home) for 14 days and not leave except to get tested or for a medical
      emergency.
    • If you answered “YES” to question 1, follow the advice of public health. You can return to school/child care after you are cleared by your local public health unit.
    • If you answered “YES” to question 3, talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test. You can return to school/child care after 14 days, even if you get a negative test result.
      • If you live in certain areas of the province, like Toronto or Peel, other people in your household
        must stay at home for 14 days. This is because of local risk factors.
      • If you live in other areas of Ontario, other people in your household can go to school, child care
        or work, but must not leave the home for other non-essential reasons for 14 days. Ask your
        school/child care for more information.
    • If you develop symptoms or test positive, contact your local public health unit or doctor/health care provider for more advice.
    • Contact your school/child care provider to let them know about this result.

    If you answered “YES” to question 2 do not go to school or child care.

    • You must self-isolate (stay home) and not leave except for a medical emergency.
    • Follow the advice of public health. You can return to school/child care after you are cleared by your local public health unit.
    • If you develop symptoms, contact your local public health unit or doctor/health care provider for more advice.
    • If you live in certain areas of the province, like Toronto or Peel, other people in your household
      must stay at home. This is because of local risk factors.
    • If you live in other areas of Ontario, other people in your household can go to school, child care or
      work, but must not leave the home for other non-essential reasons. Ask your school/child care for
      more information.
    • Contact your school/child care provider to let them know about this result.

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

    • You must self-isolate (stay home) and not leave except for a medical emergency.
    • Visit an assessment centre to get them a COVID-19 test.
      • If you test negative (you do not have the virus), you can return to school/child care.
      • If you test positive (you have the virus), you can return only after you are cleared by your local public health unit.
    • If you develop symptoms, contact your local public health unit or doctor/health care provider for more advice.
    • Siblings or other people in your household can go to school, child care or work, but must not leave the home for other, non-essential reasons until the individual who got the COVID alert tests negative, or is cleared by your local public health unit.
    • Contact your school/child care provider to let them know about this result

    If you answered “YES” to any of the symptoms included under question 5 or question 6 do not go to school or child care.

    • You must isolate (stay home) and not leave except to get tested or for a medical emergency.
    • If you answered “YES” to question 5, talk with a doctor/health care provider to get advice or an assessment, including if you need a COVID-19 test.
    • If you answered “YES” to question 6, you can return to school or child care after the individual gets a negative COVID-19 test result, or is cleared by your local public health unit, or is diagnosed with another illness.
    • Other people in your household must stay at home until you or the individual gets a
      negative COVID-19 test result, or are cleared by your local public health unit, or are
      diagnosed with other illness.
    • Contact your school/child care provider to let them know about this result.

    If you answered “NO” to all questions, you can go to school/child care because you seem to
    be healthy and have not been exposed to COVID-19. Follow your school/child care provider’s
    established process for letting staff know about this result (if applicable).

    If you have received a COVID-19 vaccination in the last 48 hours and you have mild headache,
    fatigue, muscle aches and/or joint pain that only began after immunization, and no other
    symptoms, you are to wear a surgical/procedure mask for your entire time at work. Your mask
    may only be removed to consume food or drink and you must remain at least two metres away
    from others when your mask has been removed. If the symptoms worsen, continue past 48 hours,
    or if you develop other symptoms, you should leave work immediately to self-isolate and seek
    COVID-19 testing.

    Public Health Ontario – Contact Tracing

    Answering these questions is optional.This information will only be used by Public Health officials for contact tracing. All information will be deleted in 28 days.