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Lux Mundi Daily Health Checklist
To be completed every day for all children in the Lux Mundi program.
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* Indicates required question
Child's Name
*
Your answer
Has your child, or anyone in your household, travelled outside of Canada within the last 14 days?
*
Yes
No
Has your child, or anyone in your household, been identified by Public Health as being in close contact of someone with COVID?
*
Yes
No
Has your child, or anyone in your household, been told to isolate by Public Health?
*
Yes
No
Is your child displaying any new or worsening symptoms listed below?
*
Yes
No
Symptoms
Yes
Fever or Chills
Cough or worsening chronic cough
Loss of sense of smell or taste
Shortness of breath
Loss of appetite
Nausea or vomiting
Diarrhea
Consent
I have completed the daily health checklist for my child and answered 'No' to each of the questions, therefore my child is healthy to attend the Lux Mundi program.
Your Name:
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