LPC Staff Contagious Illness Prescreening Questionnaire ({{gravity-field-id-3}})


  1. The Alberta Health Services COVID-19 SELF-ASSESSMENT (https://myhealth.alberta.ca/Journey/COVID-19/Pages/Assessment.aspx) has been truthfully completed today () for and the Alberta Health Services COVID-19 SELF-ASSESSMENT did not recommend self-isolation nor Contagious Illness testing.
  2. The Staff Member indicated above will consent to any Contagious Illness testing recommended by Alberta Health Services while serving at Lone Prairie Camp and for at least 2 weeks afterwards.
  3. The Staff Member indicated above will endeavour to maintain a healthy lifestyle including (but not limited to) healthy eating & sleep habits.

It is important that this document is signed by the participant (or their parent/guardian if the participant is under 18 years old) on the day of arrival. Please complete the Alberta Health Services COVID-19 SELF-ASSESSMENT and digitally sign this document before arrival but not before the day of arrival.

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Signature Certificate
Document name: LPC Staff Contagious Illness Prescreening Questionnaire ({{gravity-field-id-3}})
lock iconUnique Document ID: 192d1e67916d6587beec8335b421a7516625593f
Timestamp Audit
May 22, 2020 10:26 pm MDTLPC Staff Contagious Illness Prescreening Questionnaire ({{gravity-field-id-3}}) Uploaded by LPC Registrar - registrar@loneprairiecamp.com IP 68.149.136.16
May 22, 2020 10:41 pm MDT Document owner info@loneprairiecamp.com has handed over this document to registrar@loneprairiecamp.com 2020-05-22 22:41:13 - 68.149.157.40