Nursery - COVID-19 Daily Screening
Thank you for taking the time to answer these questions. The following questions are mandatory for you to complete prior to 8:30 AM daily.
Sign in to Google to save your progress. Learn more
Email *
Child's Full Name *
What is their temperature this morning? *
Question 1: Is your child experiencing any ONE of these symptoms? (including mild and/or resolved) *
Yes
No
Fever and/or chills (temperature of 37.8°C/100.0°F or greater)
Cough or barking cough
Shortness of breath / difficulty breathing
Decrease or loss of sense of taste or smell
Extreme tiredness or muscle aches
Runny or stuffy/congested nose
Headache
Sore throat or difficultly swallowing
Nausea, vomiting or diarrhea
Question 2: Has your child travelled outside of Canada in the past 14 days? *
Question 3: In the last 14 days, has your child been identified as a close contact of someone who currently has COVID-19? *
Question 4: Has a doctor, health care provider, or public health unit told you that your child should currently be isolating (staying at home)? *
Question 5: Has someone in the household travelled outside of Canada in the last 14 days who is not exempt from self-isolation because they perform an essential job (e.g., truck driver, pilot) and currently live within the home(i.e., they are not isolating at a government-funded isolation centre)? *
Question 6:  Has someone in your household been identified as a "close contact" of someone who currently has COVID-19? *
Question 7: Has someone in the household been part of a dismissed school or child care cohort in the past 14 days, and are currently at home isolating? *
Question 8:  Is someone in the household sick with the COVID-19 symptoms outlined above (new or worsening) and does not yet have a negative COVID-19 test result or alternative diagnosis from a health care provider? *
If you answered "YES" to any of the questions above, your child should stay home and not attend school.
Any additional notes including information about your child's absence from school.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of First Foundations Jewish Community Preschool. Report Abuse