Screening Tool – Visitors

Is your appointment today?

Yes
No

Are you or is anyone in your household awaiting the results of a COVID-19 test?

Yes
No

Have you been in contact in the last 14 days with someone that is confirmed to have COVID-19?

Yes
No

Do you have a new onset of any of the following symptoms: fever/chills, cough, sore throat/hoarse voice, shortness of breath, loss of taste or smell, vomiting, or diarrhea?

Yes
No

Do you have a new onset of any of the following symptoms: runny nose, muscle aches, fatigue, conjunctivitis (pink eye), headache, skin rash of unknown cause or nausea or loss of appetite?

Yes
No

Is anyone IN YOUR HOUSEHOLD showing symptoms related to COVID-19 (as noted in previous two questions)?*

Yes
No

Have you had laboratory exposure while working directly with specimens known to contain COVID-19?

Yes
No

Have you been in a setting in the last 14 days that has been identified by public health as a risk for acquiring COVID-19, such as on a flight, in a workplace with a cluster of cases, or at an event?

Yes
No

In the past 14 days, has anyone in your household travelled outside of Manitoba (excluding those exempt from self-isolation as per current Manitoba Public Health orders issued Jan. 28)?

Yes
No

Thank you, you have been successfully pre-screened for an onsite visit. Please complete the following fields and click Submit:

Name*

First Last

Email*

Phone*

My appointment date is:*

Appointment time*

: HH

MM

My meeting is with:*

We are sorry but you cannot visit the school until your conditions change. Please contact us to re-schedule your appointment.

Please complete this screening tool on the morning of your appointment.

Screening Tool – Visitors

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