Covid-19 Screening Assessment - Nuf House Academy
*NOTE* When signing this form, you are asserting that the information is true and that you have personal knowledge of the facts contained in the form. By signing, you are also stating that you are competent to and that you are of sound mind and you are over the age of 18.
Please also note that parents are responsible for taking their Childs temperature at home. Temperature will also be taken prior to entering the daycare.
Child's Last and First Name
Childs temperature this morning
1. If your child has any ONE of the following symptoms listed below, DO NOT GO TO SCHOOL OR CHILD-CARE. Stay at home and book an appointment to get a covid-19 test OR isolate for 10 days after symptoms first started AND all household members should isolate for 14 days from their last exposure to the symptomatic contact.
Fever of 37 Degrees Celsius or greater and/or Chills
Cough or Barking Cough (Croup)
Shortness of Breath
Decrease or Loss of Taste or Smell
2. If your child has any ONE of the following symptoms listed below, DO NOT GO TO SCHOOL OR CHILD-CARE. Stay at home for at least 48 hours (with no worsening symptoms) or get a covid-19 test if symptoms persist or worsen after 24 hours.
Sore Throat or Difficulty Swallowing
Runny or Stuffy/Congested Nose
Extreme Tiredness or Muscle Aches
3. In the last 14 days, has your child travelled outside of Canada?
Yes; Stay at home for 14 days after returning from travel. Check for symptoms.
4. Has a doctor, health care provider, or public health unit told you that your child should currently be isolating (staying at home)?
Yes; Do not go to school or child-care. Follow directions or health care professionals.
5. In the last 14 days, has your child been identified as a "close contact" of someone who currently has Covid-19?
Yes; Stay at home for 14 days or as directed by public health. Check for symptoms.
6. In the last 14 days, have you or your child received a COVID Alert exposure notification on their mobile/cell phone?
Yes; Do not go to school or child-care. Follow directions of public health officials.
7. Is someone that your child lives with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
Yes; Do not go to school or child-care until the person gets a negative COVID-19 test result, or is cleared by public health.
Thank you for completing the assessment form!
for information on ways to protect yourself, your family and your school community. Stay Safe and Take Care!
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