Active Screening Questionnaire for Before- and After- School in Manor Park
In response to the Coronavirus (COVID -19) outbreak and the advice given to us by Ottawa Public Health and the Ministry of Education, Before- and After- School in Manor Park is taking precautions to lessen the spread of the virus. All employees and children attending the program must have a screening form completed each day before arrival.

Active Screening is a health review of staff and your child. Completing Active Screening daily is a mandate of the Ministry of Health and Ottawa Public Health for participation in child care programs.

For your child to be permitted into the program, this form must be filled out daily.
Forms must be filled out separately for each child attending the program.

BEFORE 7:00 am for Morning Care and After Care participants;
BEFORE 1:00 pm for After Care only participants.


Information collected will only be used by the Manor Park Community Council (MPCC) for the administration and management of 'Before- and After- School in Manor Park' and will only be shared if legally required.

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Email *
Child's Name*: *
Child's Group *
Does your child attend Morning Care with us?
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Screening questions
Does your child have ONE or more of the following symptoms? Check all that apply. Those who have one or more symptoms will not be able to attend the program or enter the facility. To return to the program your child must have a negative covid test and be 24hr symptom free or self isolate for 10 days. *
Required
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you already went for a test and got a negative result, select “No.” *
In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. *
Has your child received their final (or second in a two-dose series) COVID-19 vaccination dose more than 14 days ago, or have they tested positive for COVID-19 in the last 90 days and have since been cleared? *
Is someone that the child lives with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” *
In the last 14 days, has your child travelled outside of Canada AND:• been advised to quarantine as per the federal quarantine requirements AND/OR • is the child under the age of 12 and not fully vaccinated? If travel was solely due to a cross border custody arrangement, select “No.” *
Has a doctor, health care provider, or public health unit told you that the child should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. *
In the last 10 days, has the student/child tested positive on a rapid antigen test or a home-based self-testing kit? If the student/child has since tested negative on a lab-based PCR test, select “No. *
I have knowledge of this child's health and attest that the information provided is true. *
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