Daily Screening Tool

Please complete this form daily before deciding to attend day camp.

Has the participant experienced any of the following symptoms (1-9) since last day attending program?

General Info
Screening Questions
1. Close contact with a confirmed case of COVID-19?
2. Fever > 37.8?
3. Cough or shortness of breath?
4. Sore Throat/ hoarse voice/difficulty swallowing?
5. Runny nose/sneezing/nasal congestion?*

* Check "Yes" only in the absence of underlying reason for these symptoms, such as seasonal allergies, post nasal drip etc*

6. Loss sense of smell or taste
7. Nausea/vomiting, diarrhea**, stomach pain?

** For diarrhea in children - Yes if two (2) or more unexplained episodes within a 24 hour period

8. Clinical or radiological evidence of pneumonia?
9. Atypical Symptoms (e.g. - Multisystem Inflammatory Vasculitis)?
Other