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, or anyone in your household, currently experiencing any of these symptoms? *

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

Sore throat or difficulty swallowing. Painful swallowing (not related to seasonal allergies, acid reflux, or other known causes or conditions they already have)

Runny or stuffy/congested nose. Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions they already have

Headache. Unusual, long-lasting (not related to tension-type headaches, chronic migraines, 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

Extreme tiredness or muscle aches. Unusual, fatigue, lack of energy, poor feeding in infants (not related to depression, insomnia, thyroid dysfunction, sudden injury, or other known causes or conditions they already have)

None of the above.

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