YMCAEO CHILDCARE SELF SCREENING TOOL 2021
To be filled out daily before your child is dropped off at program Failure to complete may result in your child being unable to attend the child care program. If you have any questions contact the program supervisor for further action.
PLEASE NOTE: Updated July 16, 2021-New questions have been added.
If your child is experiencing a mild headache, muscle aches, or fatigue with the onset of these symptoms occurring after receiving the COVID 19 vaccine in the last 48hrs you can select NO for these symptoms.
Email *
Parent, Staff or Visitors Name *
Select the program attending *
Participants Name (Staff record S. Visitor record V) *
Does your child have any of the following NEW or WORSENING symptoms? Symptoms should not be chronic or related to other known causes or conditions. NOTE: If you answer YES to any of these symptoms your child CAN NOT attend and you should consult your health care provider for next steps. Child is able to return when they receive a negative COVID-19 test result, an alternative diagnosis by a health care professional or it has been 10 days since their symptom onset and they are feeling better. *
Required
Is anyone in your household experiencing new or worsening symptoms of COVID-19(listed above) and /or waiting for test results after experiencing symptoms. If YES, your child CANNOT attend program until that individual receives a negative COIVD test result or an alternate diagnosis. If the person is experiencing a mild headache, muscle aches, or fatigue with the onset of these symptoms occurring after receiving the COVID 19 vaccine in the last 48hrs you can select NO. *
Has your child travelled outside of Canada within the last 14 days? NOTE: Answering YES means your child CANNOT attend the program they must self-isolate. If exempt from Federal quarantine requirements, select NO *
Has your child been identified as a close contact of someone who is confirmed as having COVID-19 by your local public health unit in the last 14 days? NOTE: Answering YES means your child CANNOT attend the program *
Has your child been directed by a health care provider including public health official to isolate? NOTE: If YES your child CAN NOT attend the program *
Have you received a COVID Alert exposure notification on your cell phone in the last 14 days (and have not been tested or waiting for your result)?If you are fully vaccinated and/or have already gone for a test and got a negative result, select "No." *
In the last ten days, have you tested positive on a rapid antigen test or a home-based self-testing kit? If you have since tested negative on a lab-based PCR test, select “No" *
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