Please Check the Appropriate Answer

1. Do any of the following apply to you?

   I am fully vaccinated against COVID-19 (please complete questions 2-6)

   YES
   

   NO
   

   I have tested positive for COVID-19 in the last 90 days (and since been cleared by the local public health unit) (please complete questions 2-6)

   YES
   

   NO
   

2. Do you have any of the following signs or symptoms?

   Cough or barking cough (croup)

   YES
   

   NO
   

   Shortness of breath (croup)

   YES
   

   NO
   

   Difficulty breathing

   YES
   

   NO
   

   New loss or decrease in sense of taste or smell

   YES
   

   NO
   

   Fever and or chills

   YES
   

   NO
   

   If adult: unexplained fatigue/ lethargy malaise muscle aches

   YES
   

   NO
   

   If child <18 years of age: nausea/vomiting, diarrhea

   YES
   

   NO
   

   IF YES YOU ARE NOT PERMITTED TO ATTEND CLASS.

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3. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?
   YES
   

   NO
   
4. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
   YES
   

   NO
   
5. In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19?
   YES
   

   NO
   
6. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?
   YES
   

   NO
   
7. In the last 10 days, have you received a COVID Alert exposure notification on your cell phone?
   YES
   

   NO
   
8. In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?
   YES
   

   NO
   
9. In the last 10 days, has someone in your household (someone you live with) been identified as a “close contact” of someone who currently has COVID-19 AND advised by a doctor, healthcare provider or public health unit to self-isolate?
   YES
   

   NO
   
10. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
    YES
    

    NO
    

If YES to Questions 3-10

YOU ARE NOT PERMITTED TO ATTEND CLASS.

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