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.
JK/SK 1 with Miss Kathleen/Jenny
JK/SK 2 with Mr. Brad/Zakia/Ms. G
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.
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)
Shortness of breath (unable to breathe deeply or feeling unable to catch one's breath)
Loss of taste or smell
Sore throat or difficulty swallowing
Runny or stuffy/congested nose
Nausea/vomiting and/or diarrhea
Extreme tiredness/muscle aches
None of the above
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
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.
I have knowledge of this child's health and attest that the information provided is true.
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