YMCAEO Child Care Self Screening Tool 2020
To be filled out DAILY for each child before entry will be permitted into a child care program. If you answer yes to ANY of the questions listed DO NOT bring your child to the program. Contact the program supervisor for further action.
Parent, Staff or Visitor's Name
Select the program your child attends
Sir John A. MacDonald
St. Margeurite Bourgeoys
Child's Name (if staff or visitor write staff or visitor)
Is your child is experiencing any of the following symptoms related to COVID-19: fever, cough, sore throat, shortness of breath, difficulty breathing or swallowing, runny nose or congestion, changes to sense of taste or smell, vomiting/diarrhea, nausea, abdominal pain, chills, headache, unexplained fatigue, rash, pink eye?
Has your child travelled outside of Canada within the last 14 days?
Has your child tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
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This form was created inside of YMCAs in Canada.