Daily Health Check Confirmation Form SD5 Date* Date Format: MM slash DD slash YYYY Location*Amy Woodland Elementary SchoolElkford Secondary SchoolFernie Secondary SchoolFrank J Mitchell Elementary SchoolGordon Terrace Elementary SchoolHighlands Elementary SchoolInternational EducationIsabella Dicken Elementary SchoolJaffray Elementary / Jr. Secondary SchoolKootenay Discovery SchoolKootenay Education ServicesKootenay Learning CampusKootenay Orchards Elementary SchoolLaurie Middle SchoolMount Baker Secondary SchoolParkland Middle SchoolPinewood Elementary SchoolRocky Mountain Elementary SchoolSchool Board OfficeSparwood Secondary SchoolSteeples Elementary SchoolT. M. Roberts Elementary SchoolOtherYour Name* First Last Administrator/Manager Email* Environmental COVID-19 check*I confirm that I have not travelled outside of Canada in the past 14 days, been identified by Public Health as a close contact of someone with COVID-19 or been told to self-isolate by Public HealthOne or more of these situations apply to meDaily Health Check*Refer to the list of common COVID-19 symptomsI confirm that I do not have any new or worsening symptoms of COVID- 19I have one or more new or worsening symptoms of COVID-19