Covid-19 Screening Tool for Children Attending Fort Erie Co-operative Preschool
Children must be screened for Covid-19 every day before going to school or child care. Parents/guardians can fill this out on behalf of a child.
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Date *
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Child's Name *
Parent/Guardian Name *
1. Is the child currently experiencing any of these symptoms? (The symptoms listed here are the symptoms most commonly associated with Covid-19. Our guidelines for children & adults continue to evolve as we learn more about Covid-19, how it spreads, and how if affects people in different ways.) Choose any/all that are new, worsening, and not related to other known causes or conditions the child already has. *
Yes
No
Fever and/or chills: Temperature of 37.8C (100F) or higher and chills
Cough or barking cough (croup): Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have)
Shortness of breath: Out of breath, unable to breath deeply (not related to asthma or other known causes or conditions they already have)
Decrease or loss of taste or smell: Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have)
Nausea, vomiting and/or diarrhea: Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have
2. Does the child currently have a runny nose?
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3. Has the child tested positive for Covid-19 in the last 90 days and have since been cleared? (If YES, you may skip questions 3, 4 & 5) *
4. Is someone that the child lives with currently experiencing any new Covid-19 symptoms and/or waiting for test results after experiencing symptoms? (If the individual experiencing symptoms received a Covid-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or join paint that only began after vaccination, select "No") *
5. In the last 10 days, has the child been identified as a "close contact" of someone who currently has Covid-19? (If public health has advised you that you do not need to self-isolate, select "No") *
6. In the last 10 days, has the child received a Covid Alert exposure notification on their cell phone? (If they already went for a test and got a negative result, select "No") *
7. In the last 14 days, has the child travelled outside of Canada AND: a) been advised to quarantine as per the federal quarantine requirements AND/OR b) is the child under the age of 12 and not fully vaccinated? (If travel was solely due to a cross border custody arrangement, select "No") *
8. Has a doctor, health care provider, or public health unit told you that the child should currently be isolating (staying at home)? (This can be because of an outbreak or contact tracing) *
9. In the last 10 days, has the child test positive on a rapid antigen test or a home-based self-testing kit? (If the child has since tested negative on a lab-based PCR test, select "No") *
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