Temple Anshe Sholom Covid-19 Screening

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Resend Confirmation

Covid-19 Screening Questions (Public Health Guidelines)

Please complete and submit before your child arrives for classes.

If your child is unwell please keep at home.

If you have any questions please contact Dora-Ann at [email protected]

Name*

Have you tested positive for Covid-19 or had close contact with a confirmed case of Covid-19 without wearing appropriate PPE in the last 14 days?

Yes
No

Did you travel outside of Canada in the past 14 days?

Yes
No

Do you have any of the following symptoms

Fever (37.8C Or Higher)
New onset of cough
Worsening chronic cough
Shortness of breath
Difficulty breathing
Sore throat (new symptom)
Difficulty swallowing
Decrease of loss of sense of taste or smell
Chills
Headaches (not typical and new)
Unexplained fatigue/malaise/muscle aches (myalgias)
Nausea/vomiting, diarrhea, abdominal pain
Pink eye (conjunctivitis)
Runny nose or nasal congestion without other known cause
No, I do not have any of these symptoms

If you answered Yes to any of these Do Not Submit .

Your child cannot be permitted to enter to ensure the safety of everyone.

Contact your health care provider as well as Public Health at 905-974-9848

Almost done. Where should we send the confirmation?

Name*

Email*

Mobile Phone Number*

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