Active Screening Questionnaire for Manor Park Child Care & Early Learning Programs

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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 and Manor Park Playschool are 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 'Manor Park Playschool' and will only be shared if legally required.

Email *

Child's Name*: *

Child's Group *

JK/SK 1 with Miss Kathleen/Gloria

JK/SK 2 with Mr. Brad/Zakia/Jenny

GR 1-2 with Fatouma/Sindy

GR 2-4 with Ndoole/Susan

GR 3-6 with Aliya/Vanessa/Halime

Bus Group with Taynikua

Manor Park Playschool

Does your child attend Morning Care with us?

Yes

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Screening questions

By completing this form you agree to answer honestly and keep your child at home if they are experiencing any symptoms or have been in close contact with a positive case.

In the last 5 days has your child experienced any of the following symptoms? Anyone who is sick or has any new or worsening symptoms of illness, including those not listed below, MUST stay home until their symptoms have been improving for 24 hours and should seek assessment from their health care provider if needed. Household members of individuals with any of the below symptoms should stay home at the same time as the person who is sick, regardless of vaccination status. *

Fever (37.8 degrees C or higher)

Cough that's new or worsening (continuous, more than usual)

Shortness of breath (unable to breathe deeply or feeling unable to catch one's breath)

Decrease or loss of taste or smell

None of the above

Required

In the last 5 days, has your chid experienced any of these symptoms? *

Sore throat or difficulty swallowing

Runny or stuffy/congested nose

Headache

Extreme tiredness

Muscle aches/joint pain

Nausea, vomiting and/or disarrhea

None of the above

In the last 5 days, has your child tested positive for Covid 19? *

Yes

Do any of the following apply? *

My child lives with someone who is currently isolating because of a positive Covid 19 test

My child lives with someone who is currently isolating because of Covid 19 symptoms.

My child lives with someone who is currently awaiting Covid 19 test results

None of the above

Has your child been identified as a "close contact" of someone who currently has Covid 19 and has been advised to self-isolate? *

Yes

Has a doctor, health care provider or public health unit told you that your child should currently be isolating (staying at home) *

Yes

Do any of the following apply? *Please note that if a child is not fully vaccinated but is exempt from federal quarantine because they travelled with a vaccinated companion, they must NOT attend school or childcare for 14 days. Select 'Yes' on the below questions if this applies to your child. *

In the last 14 days my child has travelled outside of Canada and was told to quarantine.

In the last 14 days my child travelled outside of Canada and was told not to attend school/child care.

In the last 14 days, someone my child lives with has returned from travelling outside of Canada and is isolating while awaiting results of a Covid 19 test.

None of the above

If you answered Yes to any of the above questions or if your child is experiencing any type of symptom they may not attend any of the Manor Park Child Care and Early Learning Programs (Playschool and Before and Afterschool in Manor Park). Please contact bas@manorpark.ca to let them know your child will not be attending or send a message on the HiMama app. Do you agree? *

Yes

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