Screening Tool – Visitors

Is your appointment today?

Yes
No

Are you fully vaccinated (government issued vaccine card required upon arrival for verification)?

Yes
Awaiting card but have completed first and/or second dose (will be fully vaccinated by October 29)
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*

:

My meeting is with:*

Has ANYONE in your household tested positive for COVID-19 in the past 5 days?

Yes
No

Is ANYONE in your household awaiting results of a COVID-19 test?

Yes
No

Have you had fever and/or chills TODAY or YESTERDAY?

Yes
No

Do you have any of the following symptoms TODAY:

-New or worsening cough - unrelated to an ongoing condition such as asthma or allergies
-Difficulty Breathing - unrelated to an ongoing condition such as asthma or allergies

Yes
No

Do you have any of the following symptoms TODAY

-Sore throat
-Hoarse voice
-Loss of sense of smell and/or taste

Yes
No

Have you had any of the following symptoms YESTERDAY or TODAY

-Vomiting
-Diarrhea for more than 24 hours

Yes
No

Do you have any of the following symptoms TODAY

-Runny nose
-Muscle pain (unrelated to injury)
-Unexplained fatigue
-Pink eye
-Headache
-Unexplained rash
-Nausea
-Loss of appetite

Yes
No

Are you or is anyone in your household currently required to isolate or be in quarantine?

Yes
No

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

Please note that you must be fully vaccinated (by October 29) to come into the Asper Jewish Community Campus and Gray Academy of Jewish Education. We are happy to arrange a virtual ZOOM meeting. Please connect back with us.

Please book an appointment with us first, then proceed to the screening.

Screening Tool – Visitors

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