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Active Screening Questionnaire for Manor Park Community Council staff.
Active Screening is a review of your health. Completing Active Screening DAILY is a mandate of the Ministry of Health, Ministry of Education, and Ottawa Public Health for all staff working in child care or recreation. Submitting this Questionnaire to the Manor Park Community Council (MPCC) makes it easy for you to comply.
It helps everyone remain safe and healthy!
Information collected will only be used by the MPCC for the administration and management of its child care and recreation programs. Information will only be shared as legally required.
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Do you have any of the following symptoms?
Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
Shortness of breath - Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
Decrease or loss of taste or smell - Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
Muscle aches/joint pain - Unusual, long-lasting (not related to getting a COVID-19 vaccine in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
Extreme tiredness - Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
None of the above
Do you have any of the following symptoms? (Choose any / all that a new or worsening, and are not related to other know conditions you may already have.)
Sore throat (Painful swallowing or difficulty swallowing (not related to seasonal allergies, acid reflux, post nasal drip).)ption 1
Runny or stuffy/congested nose (Not related to seasonal allergies, being outside in cold weather, chronic sinusitis unchanged from baseline.)tion 2
Conjunctivitis (pink eye) (Not related to blepharitis, recurrent styes.)
Decreased or lack of appetite (Not related to anxiety, constipation.)
Abdominal pain (Persistent or ongoing (not related to menstrual cramps, gastroesophageal reflux disease)
Headache (New and persistent, unusual, unexplained, or long-lasting (not related to tension-type headaches, chronic migraines, receiving a COVID-19 vaccine in the last 48 hours).)
Have you been in close contact with someone who has tested positive for COVID-19 in the past 14 days?
In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)?
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? (This can be because of an outbreak, contact tracing or testing positive on a Rapid Antigen Test.)
In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? If you have since tested negative on a lab-based PCR test, select 'No'.
If you have answered YES to any of the above questions or are symptomatic you should contact your program Supervisor as soon as possible, not attend work, not participate any in-person programs with the Manor Park Community Council.
for more information on being tested and self isolating. Thank you for your understanding.
Notice of Risk from Ottawa Public Health:
When children from multiple families attend a child care or recreational program, there is an increased risk of the Covid-19 virus coming into the program. Children who are infected with the Covid-19 virus are more likely than adults to have very mild infections or to have no symptoms at all, but these children can still transmit the infection to other children and to adults. This means that children can bring home an infection acquired in a child care or recreational program and put other persons at risk. Even if a program has a screening process to help detect infections when there are symptoms, this screening process will not detect infected children or adults who do not have symptoms at the time of screening.
The risk of serious Covid-19 infection increases with age, which older staff should consider in terms of risk to themselves, particularly if working in programs with children from multiple families. This caution also applies to those persons of any age who have chronic medical conditions that may put them at increased risk for serious illness with Covid-19 infection.
I am familiar with the Covid-19 Prevention Policies of the Manor Park Community Council -- found on
-- including 'Workplace Safety Plan' and 'Response Plan'.
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