Royal City - COVID Screening Survey
Please fill out this quick survey each day that you are attending class (it must be filled out day of).

If you have answered "YES" to any questions, please stay home. Contact us to discuss an appropriate schedule for your return that ensures the safety and wellness of our community.

Cold or flu-like symptoms include, but are not limited to: sore throat (painful or difficulty swallowing), runny or stuffy/congested nose (not related to seasonal allergies or other known conditions), new/unusual/long-lasting headache, fever and/or chills, cough or barking cough (croup), shortness of breath, decrease or loss of taste/smell, unusual muscle aches/joint pain, extreme tiredness

*Revised March 12, 2022 to reflect the Ontario government's COVID screening changes*
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Member name *
Current Date *
MM
/
DD
/
YYYY
In the past 5 days, have you experienced any cold or flu-like symptoms? Select "No" if you have already completed your isolation period of 5 days and you no longer have any symptoms. *
In the last 5 days, have you tested positive for COVID-19 on a rapid antigen test or PCR test? *
Has a doctor, health care provider or health care unit told you that you should currently be isolating (staying at home)? *
Is someone you live with currently isolating because of a positive COVID-19 test or COVID-19 symptoms? Select 'No' if you have previously tested positive in the past 90 days and do not currently have symptoms, you are over 18 and have received your booster dose, or you are under 18 and are fully vaccinated. *
If you have answered "NO" to ALL of the questions and DO NOT exhibit any cold or flu-like symptoms then you may proceed with your class.
Thank you for your cooperation and understanding during this time - RCCF Team
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