OAS STUDENT PRE-SCREENING
COVID-19 SELF SCREENING QUESTIONNAIRE - STUDENT
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Parents/Guardians/Students MUST use this questionnaire daily to decide if the student should attend school.
* Required
Risk Management:  Initial Screening Questions
First and Last Name of Child *
Grade Level of Child *
1. In the last 5-10 days has the student/child experienced any of these symptoms?                                   • If the student/child is fully vaccinated OR 11 years old or younger, use 5 days                                                             • If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised, use 10 days.                                                                     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 and should seek assessment from their health care provider if needed. Household members of individuals with any of the below symptoms should stay home at the same time as the person who is sick, regardless of vaccination status. If the student/child is symptomatic and has tested negative for COVID-19 on a single PCR test or two rapid antigen tests (RAT) taken 24 hours apart, and symptoms have been improving for 24 hours, you may answer “no” to all symptoms. Choose any/all that are new, worsening, and not related to other known causes or conditions they already have. *
Required
2. In the last 5-10 days has the student/child experienced any of these symptoms? • If the student/child is fully vaccinated OR 11 years old or younger, use 5 days • If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised, use 10 days Choose any/all that are new, worsening, and not related to other known causes or conditions they already have. *
Required
3. In the last 5-10 days has the student/child tested positive for COVID-19? This includes a positive COVID-19 test result on a lab-based PCR test, rapid antigen test or home-based self-testing kit.                                    • If the student/child is fully vaccinated OR 11 years old or younger, use 5 days• If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised, use 10 days. *
4. Do any of the following apply? •The student/child lives with someone who is currently isolating because of a positive COVID-19 test •The student/child lives with someone who is currently isolating because ofCOVID-19 symptoms • The student/child lives with someone who is currently isolating while waiting for COVID-19 test results.                                                                    If the individual isolating has not tested positive for COVID-19 and only has one of these symptoms: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, extreme tiredness, muscle aches or joint pain, nausea, vomiting and/or diarrhea, select “No.” *
5. Has the student/child been identified as a “close contact” of someone who currently has COVID-19 and been advised to self-isolate? If public health guidance provided to you has advised you that you do not need to self-isolate, select “No.” *
6. Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)?This can be because of an outbreak or contact tracing. *
7. Do any of the following apply?• In the last 14 days, the student/child travelled outside of Canada and was told to quarantine• In the last 14 days, the student/child travelled outside of Canada and was told to not attend school/child care• In the last 14 days, someone the student/child lives with has returned from travelling outside of Canada and is isolating while awaiting results of a COVID-19 test.  Please note that if the child/student is not fully vaccinated but is exempt from federal quarantine because they travelled with a vaccinated companion, they must not attend school or child care for 14 days. Select “yes” if this applies to the student/child. *
If you answered “YES” to ANY question, your child cannot go to school or child care. Contact your school/child care provider to let them know that your child will not be attending school today. See below for isolation and testing requirements                                                                                                  "UNPROTECTED" means close contact without appropriate personal protective equipment (PPE). 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 any of the symptoms listed under question 2, do not go to school or child care. If you answered “YES” to question 3, do not go to school or child care. If you answered “YES” to question 4, do not go to school or child care. If you answered “YES” to question 5 or 6, do not go to school or child care. If you answered “YES” to question 7, do not go to school or child care. If you answered “NO” to all questions, your child may go to school/child care. Follow your school/child care provider’s established process for letting staff know about this result.
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