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.
Email address *
Parent, Staff or Visitor's Name *
Select the program your child attends *
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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