Screening Questionnaire

PLEASE FILL OUT THIS QUESTIONNAIRE TO DECIDE IF YOU SHOULD ENTER TODAY

Initial Screening Questions:

  • COVID-19 ALBERTA HEALTH (FOR CHILDREN UNDER 18)

  • 1. Has the child:

  • 2. Does the child have any new onset (or worsening) of the following core symptoms:

  • 3. Does the child have any new onset (or worsening) of the following other symptoms:

  • COVID-19 ALBERTA HEALTH DAILY CHECKLIST (FOR ADULTS 18 YEARS AND OLDER)

  • Does the attendee have any new onset (or worsening) of any of the following symptoms:


















    • If you have answered "Yes" to any of the above questions, please DO NOT enter at this time.
    • 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.
    • Our goal is to minimize the risk of infection to our staff and children, thank you for your understanding and cooperation.
  • Child's Information

  • Date : 22/01/2021