COVID-19 Daily Morning Screening- Children
Thank you for your participation in our morning screening process. If you respond YES to your child having any COVID-19 related symptoms and your child does not have a pre-existing condition, you must keep your child home and seek further medical advise.

It is your responsibility to complete this screening questionnaire honestly and accurately in advance of the program start time, on each program day.

Using an online questionnaire will save time and energy at drop-off, avoid adding further physical distancing measures, lessen the impact of the safety measures on the participants, and streamline the data collection process. Thank you for your cooperation.

*Note: the symptoms listed here are based on those provided by the OMH: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_reference_doc_symptoms.pdf as well as symptoms listed on the Niagara Region Public Health website: https://www.niagararegion.ca/health/covid-19/

**Link to the COVID-19 school and child care screening: https://covid-19.ontario.ca/school-screening/
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Your name *
Participants First and Last Name                             Siblings can share a form as the questions are about the entire household. Staff using this form should put their name here. *
Your Phone Number *
Has anyone in your household... *
Required
Is the student/child currently experiencing any of these symptoms?   Please check any/all that are new, worsening, and not related to other known causes or conditions they already have.    *****Yes to any of the answers below means no entry. Contact your Health Care Professional for guidance and/or obtain 2 negative results (24 hours from each other) from a rapid antigen test. We ask that your child symptoms are improving for at least 24-48 hours apart (or 48 hours if gastrointestinal symptoms are present) before returning to school. *
Required
In the last [5, 10] days have you experienced any of these symptoms?       You may select “No” to all symptoms if you tested negative for COVID-19 on a PCR test, a rapidmolecular test, or two rapid antigen tests taken 24 to 48 hours apart AND you do not have a fever and your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).Choose any/all that are new, worsening, and not related to other known causes or conditions you already have. *
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or tested positive using a rapid antigen test or PCR test after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing symptoms that only began after vaccination, select “No” *
Has your child been exposed to a COVID-19-positive person (on a rapid antigen test or PCR test)? If they live with you: you should stay home for the duration of the person's isolation period. If they do not live with you and you are aged 11 or younger, you should stay home for 5 days from last exposure. *
Has your child tested positive for COVID-19 using a rapid antigen test?   Stay home for 5 days. The 5 days start from the date you tested positive if you have no symptoms, or from when your symptoms began (whichever is sooner). All of your household members (regardless of vaccination status) will need to stay home for the duration of this isolation period. *
In the last 14 days, has your child(ren) travelled outside of Canada and were told to quarantine or you travelled outside of Canada and told to not attend school/child care *
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. *
What was you child's temperature right before drop off? *
If you have more than one child, what was the second child's temperature right before drop off?
Did you administer Children's Advil, Tylenol or any other medication to lower a fever within 24 hours? *
Does your child have any underlying conditions that could be mistaken for COVID-19? *
If answered yes to the above question, please explain?  ** A doctor's note must be presented to confirm this **
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