Student screening Check – Hanul art school

Hanul Art School Student
COVID-19 SCREENING CHECKLIST

	Does the person attending the activity, have any of the below symptoms (Q1 - Q14):	YES / NO
Q1	Fever	YESNO
Q2	Cough	YESNO
Q3	Shortness of Breath/Difficulty Breathing	YESNO
Q4	Sore Throat	YESNO
Q5	Chills	YESNO
Q6	Painful Swallowing	YESNO
Q7	Runny Nose/Nasal Congestion	YESNO
Q8	Feeling Unwell/Fatigued	YESNO
Q9	Nausea/Vomiting/Diarrhea	YESNO
Q10	Unexplained loss of appetite	YESNO
Q11	Loss of sense of taste or smell	YESNO
Q12	Muscle/Joint Aches	YESNO
Q13	Headache	YESNO
Q14	Conjunctivitis	YESNO
Q15.	Have you, or anyone in your household, travelled outside of Canada in the last 14 days?	YESNO
Q16.	Have you or your children attending the program had close unprotected* contact (face-to-face contact within 2 metres/6 feet) with someone who is ill with cough and/or fever?	YESNO
Q17.	Have you 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?	YESNO
Q18.	Have you had your school or AHS contact you to self isolate within a week?	YESNO

If you have answered “YES” to any of the above questions do not participate in-Person Class.

In addition, my child and I have read and reviewed Hanul Art School’s Covid-19 Procedural Guide and Protocols provided to me over this form and through Hanul Art School’s website at www.hanulartschool.com. My child and I will do the COVID-19 screening check list before attend the Hanul Art School.

I confirm that I have read and fully understand the guidelines regarding the Screening Checklist above as well as the Hanul Art School Covid-19 Procedural Guide and Protocols and will abide by the policies listed.

Student Information

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