COVID-19 Screening Tool
All parents of children attending the centre as well as staff will be required to complete this questionnaire each day prior to entering the premises.
Are you a parent or employee of Mahmowenchike? *
What is the date today? *
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What is your name and what is your child's name (if applicable)? *
Have you or your child been in close, unprotected contact with a confirmed or probable case of COVID-19 within the past 14 days? *
Have you or your child travelled outside of Canada within the past 14 days? *
Have you or your child developed a new or worsened cough within the past 24 hours? *
Do you or your child currently have a fever of 38°C/100.4°F? *
Have you or your child experienced any shortness of breath within the last 24 hours? *
Have you or your child developed any of the following symptoms without known cause? (check all that apply) *
Required
Has your child been given a fever suppressant (i.e., Tylenol, Advil, Motrin, etc.) in the last 12 hours? *
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