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 District

 Five.

COVID-19 ALBERTA HEALTH DAILY CHECKLIST

Overview
This tool has been developed to support activity organizers and facility operators in reducing the risk of transmission of COVID-19 among attendees. The tool is meant to be used to assist with assessing attendees who may be symptomatic, or who may have been exposed to someone who is ill or has confirmed COVID-19. Attendees should fill out this checklist prior to participating in the activity or program. If an individual answers YES to any of the questions, they must not be allowed to attend or participate in the activity or program. Children and youth will need a parent to assist them to complete this screening tool. As the COVID-19 pandemic continues to evolve, this screening tool will be updated as required.

Do you/your child have any new onset (or worsening) of any of the following
symptoms:

Fever
Cough
Shortness of Breath/Difficulty Breathing
Sore Throat
Chills
Painful Swallowing
Runny Nose/ Nasal Congestion
Feeling Unwell/Fatigued
Nausea / Vomiting / Diarrhea
Unexplained Loss of Appetite
Loss of Sense of Taste or Smell
Muscle/ Joint Aches
Headache
Conjunctivitis (commonly known as Pink eye)
Has the person attending the activity/facility travelled outside of Canada in the last 14 days?
Have you/your child had close unprotected* contact (face-to-face contact within 2 meters/6 feet) with someone who has travelled outside of Canada in the last 14 days and who is ill**?
Have you/your child attending the program or activity had close unprotected* contact (face-to-face contact within 2 meters/6 feet) in the last 14 days with someone who is ill**?
Have you/your child or anyone in your household been in close unprotected* contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?

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**“unprotected” means close contact without appropriate personal protective equipment
** “ill” means someone with COVID-19 symptoms on the list above.

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