Screening Questionnaire

Risk Assessment: Initial Screening Questions:

If an individual answers YES to any of the questions, they must not be allowed to attend or participate in the activity or program. This checklist applies for all children. Children should be screened every day by completing this checklist before going to school, child care or other activities.

If your child has 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 highrisk environments. International travellers who become a case of COVID-19 after arrival in Alberta should follow isolation requirements outlined by the Government of Canada.

If your child has tested positive on a rapid antigen test or received a message from Public Health indicating that they are a case4 of COVID-19, they are required to isolate as per Public Health instructions. For more information on isolation requirements after a positive rapid antigen test, refer to the Rapid testing at home website.

This screening questionnaire will be updated as required.

Please select a school

    1. Has your child been a household contact of a case4 of COVID-19 in the last 10 days? Yes No

    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 slept over, attended a birthday party or someone who was a play date with a case.
    If the answer is “YES” AND they are NOT fully immunized5:
    • Child should stay home and NOT attend school, childcare and/or other activities for 10 days from the last day of exposure and monitor for symptoms.
        • If child answered “YES” and they are fully immunized5 or If the child answered "NO" to question 1
        • Proceed to question 2.
        2. Does the child have any new onset (or worsening) of the following core symptoms: Yes No
        Fever
        Temperature of 38 degrees Celsius or higher
        Cough
        Continuous, more than usual, not related to other known causes or conditions such as asthma
        Shortness of Breath
        Continuous, out of breath, unable to breathe deeply, not related to other known causes or conditions such as asthma
        Loss of sense smell or taste
        Not related to other known causes or conditions like allergies or neurological disorders
        If the child answered "YES" to any symptom in question 2:
        • If the child is fully immunized5 Isolate for 5 days from onset of symptoms or until symptoms resolve3 whichever is longer. After this isolation period, up to a total of 10 days past symptom onset, they are required to wear a mask when they are outside of the home, in a public place or otherwise in the company of other persons out of the household, with no exceptions.
        • If they are NOT fully immunized5, they must isolate for 10 days from the onset of symptoms or until they resolve3 whichever is longer.
        • Whether they are fully immunized or not, even if they 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, they still must isolate until symptoms resolve3.
        • If they are within three weeks of the initial positive test of a previous infection they do not need to test again, and they canleave isolation when symptoms resolve3.
        • They can use an at-home rapid test if available or the AHS Online Assessment Tool for advice on managing mild symptoms, and whether you need to be tested for COVID-19. NOTE: Children 2 years of age and younger who are not eligible for rapid testing should complete the AHS Online Assessment Tool to access molecular (e.g., PCR) testing.
            • If the child answered "NO" to all of the symptoms in question 2
            • Proceed to question 3.
            3. Does the child have any new onset (or worsening) of the following other symptoms: Yes No
            Chills
            Without fever, not related to being outside in cold weather
            Sore throat/painful swallowing
            Not related to other known causes/conditions, such as seasonal allergies or reflux
            Runny nose/congestion
            Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather
            Feeling unwell/fatigued
            Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury
            Nausea, vomiting and/or diarrhea
            Not related to other known causes or conditions, such as anxiety, medication or irritable bowel syndrome
            Unexplained loss of appetite
            Not related to other known causes or conditions, such as anxiety or medication
            Muscle/joint aches
            Not related to other known causes or conditions, such as arthritis or injury
            Headache
            Not related to other known causes or conditions, such as tension-type headaches or chronic migraines
            Conjunctivitis (commonly known as pink eye)
            If the child answered "YES" to ONE symptom in question 3:
            • Keep your child home and monitor for 24 hours and consider giving child an at-home rapid test. If the test is positive or negative see below for further instructions. NOTE: Children 2 years of age and younger who are not eligible for rapid testing should complete the AHS Online Assessment tool to access molecular (e.g., PCR) testing.
            • If at-home rapid testing is not done and the symptom is improving after 24 hours, your child can return to school and activities when they feel well enough to go.
            • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use an at-home rapid antigen test if available or follow the AHS Online Assessment Tool for advice on managing mild symptoms, and whether you need to be tested for COVID-19.
            If the child answered "YES" to TWO OR MORE symptoms in question 3: For at-home rapid antigen testing result instructions:
            • If at-home rapid test is done and is negative, they can return to school and activities when they feel well enough to go.
            • If at-home rapid test is positive, the child is required to isolate as outlined above for question 2.
            If the child answered "NO" to all questions:
            • Your child may attend school, child care and/or other activities.

            If you have answered "No" to all the above questions, please sign in and out and practice hand hygiene (wash hands for 30 seconds, and or use hand sanitizer) before and after your visit.

            Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started/until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better.

            Our goal is to minimize the risk of infection to our staff and children, thank you for your understanding and cooperation.

    3 Symptoms resolved means symptoms have improved and with no fever for 24 hours without the use of fever reducing medication

    4 A lab-confirmed case OR a probable case as defined in the Alberta COVID-19 Notifiable Disease Guideline

    5 A child 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