Active Screening Questionnaire for Manor Park Community Council staff.

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Active Screening is a review of your health. Completing Active Screening DAILY is a mandate of the Ministry of Health, Ministry of Education, and Ottawa Public Health for all staff working in child care or recreation. Submitting this Questionnaire to the Manor Park Community Council (MPCC) makes it easy for you to comply.

It helps everyone remain safe and healthy!

Information collected will only be used by the MPCC for the administration and management of its child care and recreation programs. Information will only be shared as legally required.

Your name *

In the last 5 days have you experienced any of the following symptoms? *Anyone who is sick or has new or worsening symptoms of illness, including those not listed below must stay home until their symptoms are 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. If you are symptomatic and tested negative for Covid 19 on a single PCR test or 2 rapid antigen tests (RAT) taken 24 hours apart, and symptoms have been improving for 24 hours, you may answer 'no' to all symptoms. Choose any/all that are new, worsening, and not related to other known causes or conditions that you already have. *

Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher

Cough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)

Shortness of breath - Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)

Decrease or loss of taste or smell - Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

None of the above

Required

In the last 5 days have you experienced any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions that you already have. If you have experienced only 1 (one) of these symptoms you must stay home until the symptom has been improving for 24 hours, 48 hours for vomiting or diarrhea. If you have experienced 2 (two) or more of these symptoms in the last 5 days you must self isolate 5 days from when the symptoms began and stay in isolation until all symptoms have been improving for 24 hours, 48 hours for vomiting or diarrhea, whichever is longest. *

Sore throat (Painful swallowing or difficulty swallowing)

Runny or stuffy/congested nose

Extreme tiredness (unusual fatigue, lack of energy not related to known causes or conditions that you already have)

Muscle aches or joint pain

Headache (New and persistent, unusual, unexplained, or long-lasting (not related to tension-type headaches, chronic migraines, receiving a COVID-19 vaccine in the last 48 hours).)

Nausea, vomiting and/or diarrhea (not related to ibs, anxiety, menstrual cramps or other known causes or conditions you already have)

None of the above

Required

In the last 5 days have you tested positive for Covid 19? This includes a positive test on a lab based PCR test, rapid antigen test or home based self testing kit. *

Yes

Do any of the following apply?

You live with someone who is currently isolating because of a positive covid 19 test

You live with someone who is currently isolating because of covid 19 symptoms.

You live with someone who is waiting to receive their covid 19 test results.

None of the above

Clear selection

Have you been identified as a "close contact" of someone who currently has Covid 19 and has been advised to self-isolate? If OPH has advised you that you do not need to isolate, answer 'no'.

Yes

Clear selection

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

Yes

Clear selection

Do any of the following apply? *

In the last 14 days, have you travelled outside of Canada and were told to quarantine?

In the last 14 days, have you travelled outside of Canada and were told to not attend school/childcare?

In the last 14 days, has someone you live with returned from travelling outside of Canada and they are currently awaiting results of a Covid 19 test?

None of the above

Required

If you have answered YES to any of the above questions or are symptomatic you should contact your program Supervisor as soon as possible, not attend work, and not participate any in-person programs with the Manor Park Community Council.

Visit www.ottawapublichealth.ca for more information on being tested and self isolating. Thank you for your understanding.

Notice of Risk from Ottawa Public Health:

When children from multiple families attend a child care or recreational program, there is an increased risk of the Covid-19 virus coming into the program. Children who are infected with the Covid-19 virus are more likely than adults to have very mild infections or to have no symptoms at all, but these children can still transmit the infection to other children and to adults. This means that children can bring home an infection acquired in a child care or recreational program and put other persons at risk. Even if a program has a screening process to help detect infections when there are symptoms, this screening process will not detect infected children or adults who do not have symptoms at the time of screening.

The risk of serious Covid-19 infection increases with age, which older staff should consider in terms of risk to themselves, particularly if working in programs with children from multiple families. This caution also applies to those persons of any age who have chronic medical conditions that may put them at increased risk for serious illness with Covid-19 infection.

I am familiar with the Covid-19 Prevention Policies of the Manor Park Community Council -- found on manorpark.ca -- including 'Workplace Safety Plan' and 'Response Plan'.

Yes

Clear selection

Submit

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