Covid-19 Screening Form

    Introduction:

    • Everyone planning to attend an in-person program at an Innisfil ideaLAB & Library location is required to complete the pre-screening for COVID-19
    • Screening must be completed daily, before attending a program or an ideaLAB & Library branch.
    • This screening tool is based on the Ministry of Health’s COVID-19 Patient Screening Guidance Document, V11 Feb 4 2022
    • This information will be maintained in accordance with the Library’s Confidentiality and Protection of Privacy Policy, and will only be provided to the Simcoe Muskoka District Health Unit when necessary for contact tracing purposes related to the COVID-19 pandemic

    Fully vaccinated is defined as at least 14 days after receiving the second dose of a two-dose COVID-19 vaccine series.

    Your Information




    Fully vaccinated is defined as at least 14 days after receiving the second dose of a two-dose COVID-19 vaccine series.

    Screening Questions


    For individuals 18 years of age or older

    1. In the last 10 days have you experienced any new or worsening symptoms below?
    Choose any/all that are new, worsening, and not related to other known causes or medical conditions.

    Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or
    higher

    Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have

    Not related to asthma or other known causes or conditions you already have

    Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

    2. In the last 10 days have you experienced any 2 or more new or worsening symptoms below?

    Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have or a COVID-19 vaccination in the last 48 hours)

    Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have or a COVID-19 vaccination in the last 48 hours)

    painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)

    Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have.

    new, unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)

    Not related to irritable bowel syndrome, anxiety, menstrual cramps, medication side effects, or other known causes or conditions you already have

    For individuals under the age of 18

    1. In the last 10 days have you experienced any new or worsening symptoms below?

    Choose any/all that are new, worsening, and not related to other known causes or medical conditions.

    Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or
    higher

    Continuous, more than usual, making a whistling noise when breathing, not related to other known causes or conditions (for example, asthma, post-infectious reactive airways, COPD)

    Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma)

    Not related to other known causes or conditions (for example, allergies, neurological disorders)

    2. In the last 10 days have you experienced any 2 or more new or worsening symptoms below?

    Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have or a COVID-19 vaccination in the last 48 hours)

    Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have or a COVID-19 vaccination in the last 48 hours)

    Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)

    (not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have)

    New, unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have, or it you received a COVID-19 and/or flu vaccination in the last 48 hours and are only experiencing a mild headache that only began after vaccination)

    Not related to other known causes or conditions (for example, irritable bowel syndrome, menstrual cramps)

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

    4. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying home)?
    Note: staying at home/self-isolation can be because of an outbreak or contact tracing.

    5. In the last 10 days, have you tested positive for COVID-19?”
    Note: includes a positive result on a lab-based PCR test, rapid antigen test or a home-based self-testing kit.

    6. Do you live with someone who is:

    1. Currently isolating because of a positive COVID-19 test?
    2. Currently isolating because of COVID-19 symptoms?
    3. Waiting for COVID-19 test results?

    Note: if you tested positive for COVID-19 within the last 90 days and have already
    completed your isolation period, select “No”.

    7. In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19 and doesn’t live with you?

    Note: If you are fully vaccinated or have tested positive for COVID-19 within the last 90 days and have already completed your isolation period, select “No”.