Harmony Child Screening Form  
Harmony Childcare Centre will be conducting screening prior to allowing children to enter the day care.  Please complete this form on behalf of your child prior to arriving at the centre.  Upon arriving at Harmony's screening area, this form will be reviewed and your child's temperature will be taken and recorded prior to entering the classroom.  A wellness check will be conducted at the screening area as well prior to children being allowed in.

If you have multiple children attending the centre, you will be required to complete an online screening form for each child. This needs to be completed for ALL children attending a program here - PreS, JK, SK and SA.

Daily submissions CANNOT BE SUBITTED PRIOR TO 6:00 a.m. on the day your child is expected in care or the submission will be considered invalid and you'll have to complete it again or fill out a paper copy once you get to the day care.

ALL OF THE QUESTIONS ARE FOR "NEW OR WORSENING" SYMPTOMS.  ALL SYMPTOMS LISTED BELOW SHOULD NOT BE CHRONIC OR RELATED TO OTHER KNOW CAUSES OR CONDITIONS.

If the symptom is from a known health condition that gives them the symptom, select "NO". If the symptom is new, different or getting worse, select "YES"(stay home and self-isolate).

If there is mild tiredness, sore muscles or joints within 48 hours after COVID-19 vaccine, select "NO". If longer than 48 hours, select "YES"(stay home and self-isolate).

Anyone who is sick or has any symptoms of illness, should stay home and seek assessment from their health care provider if needed.
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Full Name of Parent/Guardian Completing Form *
Emergency Phone Number *
Child's First Name *
Child's Last Name *
Classroom child is attending: *
Required
#1. A) Does the child or anyone in the household have 1 or more of these new or worsening symptoms?  FEVER *
A FEVER and/or CHILLS of 37.8 C / 100 F or greater.
A FEVER and/or CHILLS of 37.8 C / 100 F or greater.
COUGH. More than the usual if chronic cough...including croup (barking cough, making a whistling noise when breathing).  Not related to other known causes or conditions (e.g. asthma, reactive airway) *
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DIFFICULTY BREATHING / SHORTESS OF BREATH (dyspnea, out of breath, unable to breathe deeply, wheeze...that is worse than usual if chronically short of breath) Not related to other known causes or conditions (e.g. asthma) *
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DECREASE OR LOSS OF SMELL OR TASTE (new olfactory or taste disorder) Not related to other known causes or conditions (e.g. nasal polyps, allergies, neurological disorders) *
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#1. B) Does the child or anyone in the household have 2 or more of these new or worsening symptoms?  SORE THROAT *
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HEADACHE? *
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FEELING VERY TIRED? *
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RUNNY NOSE / NASAL CONGESTION? *
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MUSCLE ACHES / JOINT PAIN?
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NAUSEA, VOMITING OR DIARRHEA?
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#2. Has the child or anyone in the household tested positive for COVID-19 (on a rapid antigen test or PCR test) or has the child been told to stay home and self-isolate? If "YES": Stay home and self-isolate.
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#3. In the last 10 days has the child been notified as a close contact of someone with COVID-19, or received a COVID Alert notification? If 'YES': Stay home and self-isolate.
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#4. In the last 14 days, has the child travelled outside of Canada? If "YES", follow federal quarantine travel rules.
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