copy daily screening-COVID-19 Screening Tool

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to be completed daily prior to entering child care premises/providing child care

First and Last Name (person being screened) *

person being screened is: (select one) *

child

staff

visitor

person ordinarily resident at the premises

Screening Questions:

Please note: answer YES only for symptoms which are NEW or WORSENING. Symptoms related to preexisting conditions such as allergies, asthma, or teething are not relevant. (exception: fevers 37.8C or higher, associated with teething cannot be admitted to care)

Fever? *

37.8 C or higher

yes

new or worsening cough? *

Yes

shortness of breath *

Yes

sore throat, trouble swallowing? *

Yes

Runny nose? *

NOT related to seasonal allergies or other known conditions

Yes

Loss of taste or smell? *

Yes

Not feeling well? *

e.g. chills, fatigue, pink eye, lack of appetite

Yes

Nausea, vomiting, diarrhea? *

Yes

In the past 14 days has the person being screened traveled outside of Canada or had close contact with another individual who has? *

Yes

In the past 14 days, has the person being screened had close contact with a confirmed case of COVID-19? *

Yes

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