Health form

Sector*

Pour accéder à un bâtiment de la Commission scolaire de la Moyenne-Côte-Nord, vous devez remplir un formulaire d’état de santé. Cliquez sur le nom du bâtiment que vous devez fréquenter.

Havre-Saint-Pierre area
West area
East area

Havre-Saint-Pierre sector

Administrative center
Monseigneur-Labrie school
Niapiska residence
Centre d’éducation des adultes de la Minganie
Leventoux school
Lestrat school

West Sector

Louis-Garnier school (Rivière-au-Tonnerre)
Notre-Dame-de-la-Confiance school (Rivière-Saint-Jean)
Saint-François-d’Assise school (Longue-Pointe-de-Mingan)

East Sector

Saint-François-Régis school (Baie-Johan-Beetz)
Notre-Dame-de-Grâce school (Aguanish)
Notre-Dame-des-Anges school (Natashquan)

First and last name of employee:*

First Last

Have you been diagnosed with COVID-19?*

Yes
No

Are you currently in a period of isolation?*

Yes
No

Have you been in close contact with someone diagnosed with COVID-19 for the past two weeks?*

Yes
No

Do you have any of the following symptoms:

Apparition ou aggravation d’une toux;
Fever (temperature de 38^oC and above, in mouth);
Breathing difficulties;
Sudden loss of smell without nasal congestion, with or without loss of taste.

Do you have any of the following symptoms:

A general symptom (muscle pain, headache, severe fatigue or severe loss of appetite);
Sore throat;
Diarrhea.

OUTIL DE TRIAGE À L’ATTENTION DES SERVICES DE GARDE ET MILIEU SCOLAIRE