Student screenning Check

Hanul Art School Student
COVID-19 SCREENING CHECK
LIST

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

First Name:

Last Name:


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228 91St, Edmonton, AB, T6X 1W8