Health Screening Questionnaire For Staff

  • Health Screening Questionnaire For Staff


    This questionnaire must be completed by each individual staff member prior to participating in school day activities. The answer to all questions must be “No” to be at work. If an individual answers “yes” to any of these questions, they are not permitted to remain at school or participate in any school activities. Please note: This Health Screening questionnaire 
    has been developed based on the current Ontario Ministry of Health Self-Assessment Tool.

  • Do you have any of the following symptoms?

  • (not related to seasonal allergies or other known causes or conditions)

  • (not related to seasonal allergies or other known causes
    or conditions)

  • (not related to other known causes or conditions)

  • Close physical contact means:

    • being less than 2 meters away in the same room, workspace, or area
    • living in the same home
  • (See above for ‘close contact’)

  • (See above ‘close contact’)

  • (See above ‘close contact’)