Adult Daily Screening Checklist 2022
UPDATED AS OF 9FEB2022. THIS FORM MUST BE COMPLETED ON THE SAME DAY OF THE ACTIVITY ATTENDING.

If an individual answers YES to any of the questions, they are not allowed to attend or participate in any activity or program.

DISCLAIMER: By entering your name below you acknowledge that the information provided in this checklist is true and accurate.

Updated to reflect any Government of Alberta and Alberta Health Services changes as of 9 February 2022
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OVERVIEW
This tool was developed to support Albertans in protecting others and reducing the risk of transmission of
COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of
COVID-19.
If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing,
Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high risk environments. International travellers who become a case after arrival in Alberta should follow isolation requirements outlined by Government of Canada.
If you have tested positive on a rapid test, you are required to isolate as per current Public Health instructions. For more information on isolation requirements after a positive rapid test, refer to the Rapid Testing at Home website.

Case (1) - A lab-confirmed case OR a probable case as defined in the Alberta COVID-19 Notifiable Disease Guideline
Immunized (2) - A person who has received the complete vaccine series for COVID-19 and it has been 14 days after the second dose in a two dose series or one dose in a one dose series (i.e., Janssen vaccine)
Symptoms(3) - Symptoms resolve means symptoms have improved and with no fever for 24 hours without the use of fever reducing medication

SCREENING QUESTIONS for ADULTS 18 YEARS AND OLDER:
1. Have you been a household contact of a case(1) of COVID-19 in the last 10 days? (A household contact: a person who lives in the same residence as the case OR who has been in frequent, long-duration, close-range interaction with a case of COVID-19. For example, someone who is a caregiver or an intimate or sexual partner of a COVID-19 case. *
If you answered “YES” AND you are NOT fully immunized(2):
• You should stay home for 10 days from the last day of exposure and monitor for symptoms. unless you have tested positive for COVID-19 in the last 90 days AND completed your mandatory 10-day isolation period, in which case you can proceed to question 2.
If you answered “YES” AND you are fully immunized(2) proceed to question 2:
If you answered “NO” to question 1, proceed to question 2:
1) Do you have any new onset (or worsening) of any of the following symptoms: *
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If you answered “YES to any symptom”:
• Stay home
• You can use an at-home rapid test if available or the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If you have fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell, you are required to isolate as per the current CMOH Order:

• If you are fully immunized(2): Isolate for 5 days from the onset of symptoms or until they resolve(3) whichever is longer.  After the isolation period, up to a total of 10 days from the day of symptom onset, your are required to wear a mask at all times when in a pubic place or otherwise in the company of other persons with no exceptions.

• If you are NOT fully immunized(2) you must isolate for 10 days from the day of onset of symptoms or until they resolve(3) whichever is longer

• Whether you are fully immunized or not, even if you have a negative molecular(e.g. PCR) COVID-19 test or two negative rapid antigen tests, taken not less than 24 hours of each other, you still must isolate until symptoms resolve(3)

• If you are within three weeks of the initial positive test of a previous infection you do not need to test again, and you can leave isolation when symptoms resolve.

NOTE: If you have recently recovered from a previously confirmed COVID-19 infection and are within three weeks of the initial positive test, you do not need to get tested. If three weeks have elapsed by your are within 90 days from the initial positive test, you are recommended to take a rapid antigen test.

If you answered “NO”:
• You may attend work, school, and/or other activities.
• Asymptomatic close contacts of a confirmed COVID-19 case who are healthcare workers are subject to testing requirements as per CMOH Orders or their organizational policy.
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