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COVID-19 ALBERTA HEALTH DAILY CHECKLIST 

Today's Date: September 18, 2021

First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

(FOR ADULTS 18 YEARS AND OLDER) 

Overview

This tool was developed to support Albertans in protecting others and reducing the risk of transmission of COVID-19. Adults 18 years and older can complete this checklist every day to self-monitor for symptoms of COVID-19.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

Screening Questions for Adults 18 Years and Older: 

1. Do you have any new onset (or worsening) of the following symptoms: 

Fever*
Yes
No
Cough*
Yes
No
Shortness of breath*
Yes
No
Runny nose*
Yes
No
Sore throat*
Yes
No
Chills*
Yes
No
Painful swallowing*
Yes
No
Nasal congestion*
Yes
No
Feeling unwell / fatigued*
Yes
No
Nausea / vomiting / diarrhea*
Yes
No
Unexplained loss of appetite*
Yes
No
Loss of sense of taste or smell*
Yes
No
Muscle / joint aches*
Yes
No
Headache*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If you answered "YES" to any symptom: 

  • Stay home.  
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation. 
  • Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities.

If you answered "NO":

  • You may attend work, school, and/or other activities. 

(FOR CHILDREN UNDER 18) 

Overview

This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.

If your child has traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments.

Screening Questions for Children under 18: 

1. Does the child have any new onset (or worsening) of the following core symptoms: 

Fever Temperature of 38 degrees Celsius or higher*
Yes
No
Cough Continuous, more than usual, not related to other known causes or conditions such as asthma*
Yes
No
Shortness of breath Continuous, unable to breathe deeply, not related to other known causes or conditions such as asthma*
Yes
No
Loss of sense of smell or taste Not related to other known causes or conditions like allergies or neurological disorders*
Yes
No

If the child answered "YES" to any symptom in question 1:

  • The child is required to isolate for 10 days from onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional information on isolation.

If the child answered "NO" to all of the symptoms in question 1, proceed to question 2. 

2. Does the child have any new onset (or worsening) of the following other symptoms: 

Chills Without fever, not related to being outside in cold weather*
Yes
No
Sore throat/painful swallowing Not related to other known causes/conditions, such as seasonal allergies or reflux*
Yes
No
Runny nose/congestion Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather*
Yes
No
Feeling unwell/fatigued Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury*
Yes
No
Nausea, vomiting and/or diarrhea Not related to other known causes/conditions, such as anxiety, medication or irritable bowel syndrome*
Yes
No
Unexplained loss of appetite Not related to other known causes/conditions, such as anxiety or medication*
Yes
No
Muscle/joint aches Not related to other known causes/conditions, such as arthritis or injury*
Yes
No
Headache Not related to other known causes/conditions, such as tension-type headaches or chronic migraines*
Yes
No
Conjunctivitis (commonly known as pink eye)*
Yes
No

If the child answered "YES" to ONE symptom in question 2:

  • Keep your child home and monitor for 24 hours.
  • If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
  • If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered "YES" to TWO OR MORE symptoms in question 2:

  • Keep your child home.
  • Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
  • Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered "NO" to all questions:

  • Your child may attend school, childcare and/or other activities. 

Please note: If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started or until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better. 

Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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