COVID SCREEN

Please complete the following screening for each member of your family that is attending Fresh Start programming:

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1. Do you hve any of the following symptoms?
2. Have you traveled internationally within the last 14 days (outside Canada)?
3. Have you had close contact (within 6 feet for more than 15 minutes) with anyone that has tested positive for COVID-19 ?
4. Have you had close contact (within 6 feet for more than 15 minutes) with someone that has COVID-19 like symptoms in the last 14 days?
5. Have you had contact with anyone in self-isolation or awaiting the results of a COVID-19 test in the past 14 days?

COVID SCREEN

Please complete the following screening for each member of your family that is attending Fresh Start programming:

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1. Do you hve any of the following symptoms? Please check all that apply.
2. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
3. In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID-19?
4. In thte last 14 days, have you received a COVID alert exposure notification on your cell phone?
5. In the last 14 days, have you or anyone you live with travelled outside of Canada?
6. Is anyone you live with currently experiencing any new COVID-19 Symptoms and/or waiting for test results after experiencing symptoms?