COVID-19 Screening Checklist

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Please fill out the below screening prior to entry at Playtopia. If you have answered yes to any of the below questions, PLEASE DO NOT ENTER PLAYTOPIA. Please call us if you have answered yes to any of the below questions and we will assess the situation and give next steps. This will also serve as a form of contact tracing, which is why your phone number is required.

Email *

Name of Guest(s) * please enter the name of all individuals entering with you* *

Phone Number *

Reason for coming to Playtopia *

In the last 14 days, has anyone on this form travelled outside of Canada? *

Yes

Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)? *

Yes

In the last 14 days, has anyone on this form been identified as a “close contact” of someone who currently has COVID-19? *

Yes

Is anyone on this form currently experiencing fever and/or chills? (temperature of 37.8 degrees Celsius or higher) *

Yes

Is anyone on this form currently experiencing cough or barking cough (croup)? *

Yes

Is anyone on this form currently experiencing shortness of breath? *

Yes

Is anyone on this form currently experiencing decrease or loss of taste or smell? *

Yes

Is anyone on this form currently experiencing sore throat or difficulty swallowing? *

Yes

Is anyone on this form currently experiencing runny or stuffy/congested nose? *

Yes

Is anyone on this form currently experiencing headache? *

Yes

Is anyone on this form currently experiencing nausea, vomiting and/or diarrhea? *

Yes

Is someone that anyone on this form lives with, currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *

Yes

If you answered “NO” to all questions, you and those listed on this form may enter Playtopia because they seem to be healthy and have not been exposed to COVID-19. Thank you for doing your entry screening! Please show confirmation of completing this form to the person at the gate! thank you again!! *

I answered "YES" to one or more questions and cannot come in. Please call us at 905-695-2511.

Thank you! I have answered "NO" to all questions and therefore can enter Playtopia

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