R.S.O.S.C.S-Daily Health Screening Questionnaire
Attention Please! Parents or guardians must fill out this questionnaire to decide if their child should enter the program each day. It MUST be submitted to us BEFORE your child attends the program. If you are unable to fill out the form and we are not able to verify with you have been able to complete the screening on your child, your child may be denied entrance into the program for that day. Our Goal is to minimize the risk of infection to our staff and children. Thank you for understanding and cooperation.
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1. What is your child/ren's names? (If you have more than one child attending our program, you will only need to fill in the form once, but please make sure that you include both of your children's names) *
2. Which RSOSC location is your child/ren at ? *
3. What school is your child/ren attending?
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4. Please document the date of filling out the questionnaire. *
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5. Please document the time of filling out this questionnaire.
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6. Does your child attending the program, have any new onset (or worsening) of following core symptoms ? If yes, the child is to isolate for 10 days from onset of symptoms or Call health link 8-11 to arrange for testing or receive additional information on isolation. *
Required
7. Does the child have any new onset(or worsening) of the following other symptoms? If yes to one symptom, keep your child home and monitor for 24 hours. If the symptom is improving, they can return. If the symptom does not improve or worsens after 24 hours or with two or more symptoms appear, please call health like 8-11 for checking if testing is recommemded. or You child can return once their symptoms go away as long as it has been at least 24 hours since their symptoms started. *
Required
8. Has your child traveled outside of Canada in the last 14 days? If yes, the child is required to quarantine for 14 days, or if the child develops symptoms, please call health link 8-11 to determine for if testing is recommended. *
9. Has your child had close contact with a case of COVID-19 in the last 14 days? (Face-to face contact within 2 metres for 15 minutes or longer, or direct physical contact such as hugging) If yes, the child is required to quarantine for 14 days, or if the child develops symptoms, please call health link 8-11 to determine for if testing is recommended. *
10. Please note if your child has any symptoms listed above or have answered "Yes" to any above questions, your child will NOT BE ABLE TO ATTEND the program at this time. If your child has specific health concerns that we should be aware of, please clarify below. Thank you.
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