Lyonsgate Elementary Campus Screening Form

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This form must be completed every day, for each child, after 5:00 a.m. and before your child arrives at school. If this online form is not completed, parents or primary caregivers are required to answer all screening questions in person when dropping students off at Lyonsgate Montessori School's Elementary campus. This form is the same as the Provincial School and Child Care Screening Tool.

Child's First Name: *

Child's Last Name: *

Name of parent/caregiver completing this screening form: *

Are they currently experiencing any of these symptoms? *

The symptoms listed here are the symptoms most commonly associated with COVID-19. If you have these symptoms, you should isolate and seek testing. Please note that rapid antigen testing is not to be used for those with symptoms of COVID-19 or for contacts of known COVID-19 cases. Anyone who is sick or has any symptoms of illness, including those not listed below, should stay home and seek assessment from their health care provider if needed. Choose the main symptom that is new, worsening, and not related to other known causes or conditions they already have.

Fever and/or chills (37.8C/100.0F 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, or other known causes or conditions they already have)

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

Decrease or loss of taste or smell. Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have

Nausea, vomiting, and/or diarrhea. Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have

None of the above.

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