Instructor COVID Screening

Our Studio
CLASSES
Pricing & Services
Contact Us
Blog

Instructor COVID
Screening Survey

Instructors, please fill out our COVID Screening Survey the day of your class...thank you!

* Indicates required field

Name *

First

Last

Email *

Are you currently experiencing any of these symptoms? *

Fever and/or chills Cough or barking cough Shortness of breath Muscle aches/joint pain Extreme tiredness Decrease or loss of taste or smell Runny or stuffy/congested nose Sore throat Headache Nausea, vomiting and/or diarrhea None of the above

In the last 5 days has someone you live with: *

Been sick with symptoms associated with COVID-19? and/or Tested positive for COVID-19 (on a rapid antigen test or PCR test?) None of the above

In the last 5 days, have you tested positive on a rapid antigen test or home-based self-testing kit? *

Yes No

If you have since tested negative on a lab-based PCR test, select "No."

In the last 5 days, have you received a COVID Alert exposure notification on your cell phone? *

Yes No

If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.” If you already went for a test and got a negative result, select “No.”

IN THE LAST 5 DAYS, HAVE YOU BEEN IDENTIFIED AS A “CLOSE CONTACT” OF SOMEONE WHO CURRENTLY HAS COVID-19? Confirmed by a PCR or Rapid Antigen test *

Yes No

If public health has advised you that you do not need to self-isolate, select "No"

In the last 14 days, have you travelled outside of Canada? *

Yes No

If exempt from federal quarantine requirements as directed by the border agent at your point of entry (for example, you have two or more doses of a COVID-19 vaccine and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.”

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *

Yes No

Have you been in close physical contact with someone experiencing symptoms of covid in the last 5 days? *

Yes No

Close physical contact means any of the following while NOT wearing PPE: -being less than 2 meters away in the same room, workspace or area. -living in the same home.

Submit

CONTACT US

20 Freel Lane
Stouffville, ON
L4A 8B9
905.642.4600