This tool has been developed to support schools, activity organizers, employers, businesses and
facility operators in reducing the risk of transmission of COVID-19 among attendees/staff. 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 complete this checklist prior to participating in the activity or program. Children and
youth may need a parent to assist them to complete this screening tool.

If an individual answers YES to any of the questions, they must not be allowed to attend or
participate in the activity or program. *Individuals with fever, cough, shortness of breath, runny nose, or
sore throat, are required to isolate for 10 days per CMOH Order 05-2020 unless they receive a negative
COVID-19 test and are feeling better. Use the AHS Online Assessment Tool to determine if testing is
recommended and follow information on isolation requirements.

As the COVID-19 pandemic continues to evolve, this screening tool will be updated as required.

Screening Questions