Daily Active Screening Questionnaire for Summer Camp Participants
Active Screening is a health review of your child. Completing Active Screening daily is a mandate of the Ministry of Health and Ottawa Public Health for participation in day camps. Submitting this Questionnaire makes it easy for you to comply.
It helps everyone remain safe and healthy!
Information collected will only be used by the Manor Park Community Council (MPCC) for the administration and management of 'Summer Day Camps in Manor Park' and will only be shared if legally required.
I hereby declare that the below information is truthful
Does the camper have one or more of the following symptoms? Check all that apply. Please note that you may be asked to confirm your child's temperature upon arrival. Those who have 1 or more symptom will unfortunately not be able to attend the program or enter the facility.
Fever (37.8 degrees C or higher)
Cough that's new or worsening (continuous, more than usual)
Barking cough, making a whistling noise when breathing (croup)
Runny, stuffy, or congested nose (not associated with allergies or other known condition)
Lost sense of taste or smell
Pink eye (conjunctivitis)
Headache that's unusual or long-lasting
Digestive issues (nausea / vomiting, diarrhea, stomach pain)
Extreme tiredness that is unusual (fatigue, lack of energy)
Falling down often
Sluggishness or lack of appetite
None of the above
Does the camper have an inflammatory condition? Check all that apply. NOTE: A doctor's note is required to return to camp.
Abnormal swelling in the hands or feet that requires medical attention
None of the above
As parent / guardian of the camper, I attest that: my child has NOT travelled outside of Canada (including the United States) in the last 14 days; my child has NOT had close contact with a confirmed or probable Covid-19 case, and my child has NOT had close contact with a person with acute respiratory illness who has been outside of Canada (including the United States) in the last 14 days.
Yes, I attest.
No, I do not attest.
I have received the 'Summer Day Camps in Manor Park: Guide for Parents and Guardians 2020', and the link to the pre-camp welcome video. NOTE: Also available online at
Notice of Risk from Ottawa Public Health:
When children from multiple families attend a day camp, there is an increased risk of the Covid-19 virus coming into the camp. Children who are infected with the Covid-19 virus are more likely than adults to have very mild infections or to have no symptoms at all, but these children can still transmit the infection to other children and to adults at the camp. This means that children can bring home an infection acquired in a camp and put other persons at risk. Even if a day camp has a screening process to help detect infections when there are symptoms; this screening process will not detect infected children or adults who do not have symptoms at the time of screening.
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