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, V. 6.0 - June 30, 2021. 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 First Name: Last Name: Email: Phone Number Fully vaccinated is defined as at least 14 days after receiving the second dose of a two-dose COVID-19 vaccine series. Screening Questions Age Range 18 Years of age or olderUnder 18 years of age For individuals 18 years of age or older 1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions. Choose any/all that are new, worsening, and not related to other known causes or medical conditions. Fever and/or Chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher YesNo Cough or barking cough (croup) Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have YesNo Shortness of Breath Not related to asthma or other known causes or conditions you already have YesNo Decrease or loss of smell or taste Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have YesNo Muscle aches Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have) If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild muscle aches/joint pain that only began after vaccination, select “No.” YesNo Fatigue Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have) If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.” YesNo For individuals under the age of 18 1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions. Choose any/all that are new, worsening, and not related to other known causes or medical conditions. Fever and/or Chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher YesNo Cough or barking cough (croup) 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) YesNo Shortness of Breath Out of breath, unable to breathe deeply, not related to other known causes or conditions (for example, asthma) YesNo Decrease or loss of smell or taste Not related to other known causes or conditions (for example, allergies, neurological disorders) YesNo Nausea, vomiting and/or diarrhea Not related to other known causes or conditions (for example, irritable bowel syndrome, menstrual cramps) YesNo 2. Have you Travelled outside of Canada in the last 14 days? In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements? If you are not fully vaccinated and you live with someone who travelled outside of Canada, see Notes below. If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” YesNo 3. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? If you are fully vaccinated and have not been advised to self-isolate by public health, select “No”. YesNo 4. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. YesNo 5. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you are fully vaccinated and/or have already gone for a test and got a negative result, select "No." YesNo 6. In the last 10 days, have you tested positive on a rapid antigen test or a homebased self-testing kit? If you have since tested negative on a lab-based PCR test, select “No." YesNo 7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If you are fully vaccinated, select “No.” YesNo Δ
