top of page

COVID-19 Pre Screening Checklist

Please ensure you screen NEGATIVE before attending your scheduled in Dojo classes. 

Screening Questions

This screening tool is based on the latest COVID-19 case definitions and the Coronavirus disease (COVID-2019) situation reports published by the World Health Organization. 

If response to ALL of the screening questions is NO: COVID Screen Negative

Question 1

Do you have a concern for a potential COVID-19 infection for the person (e.g. is there an outbreak in the facility, is the patient awaiting COVID-19 test results, etc)?

Question 2

Have you traveled outside of Canada in the past 14 days?

Question 3 

Have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?

Question 4

Do you have any of the following symptoms? • Fever • New onset of cough • Worsening chronic cough • Shortness of breath • Difficulty breathing • Sore throat • Difficulty swallowing • Decrease of loss of sense of taste or smell • Chills • Headaches • Unexplained fatigue/malaise/muscle aches (myalgias) • Nausea/vomiting, diarrhea, abdominal pain • Pink eye (conjunctivitis) • Runny nose or nasal congestion without other known cause

+1 519-575-3865

©2019 by Mapleton Martial Arts. Proud member of CNGK

bottom of page