COVID-19 Daily Screening - Vaughan Students

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for taking the time to answer these questions. The following questions are mandatory for you to complete PRIOR to the start of session, daily. (Updated January 11, 2022)

Email *

Child's full name *

What was your child's temperature this morning? *

QUESTION 1: Is your child experiencing ANY major symptoms of COVID-19? Select all that apply. *

If you selected "YES" to any of the symptoms below, your child should stay home and not attend Kid Mechanix. Your child must isolate for 5 days from when symptoms started and stay in isolation until they are symptom free for 24 hours. Household members, including siblings, must stay home at the same time as the your child, whether they are fully vaccinated or not.

Fever/Chills

Cough

Shortness of Breath

Decrease/Loss of Taste and/or Smell

None of the Above

Required

QUESTION 2: Is your child experiencing ANY minor symptoms of COVID-19? Select all that apply. *

If you selected "YES" to any symptoms below, your child should stay home and not attend school. If your child is experiencing only one of these symptoms in the last 5 days the child must stay home until symptom free for at least 24 hours (48 hours for nausea, vomiting and/or diarrhea). If your child has experienced two or more of these symptoms in the last 5 days your child must isolate for 5 days from when symptoms started and stay in isolation until they are symptom free for 24 hours (48 hours for nausea, vomiting and/or diarrhea). If your child has two or more minor symptoms, household members, including siblings, must stay home at the same time as the your child, whether they are fully vaccinated or not.

Sore Throat

Headache

Extreme Fatigue

Runny Nose and/or Nasal Congestion

Muscle/Joint Pain

Gastrointestinal Symptoms (vomiting, diarrhea)

None of the Above

Required

QUESTION 3: Check the following that apply: *

The student/child lives with someone who is currently isolating because of a positive COVID-19 test.

The student/child lives with someone who is currently isolating because of COVID-19 symptoms.

The student/child lives with someone who is currently isolating while waiting for COVID-19 test results.

None of the above apply to my child

Required

QUESTION 4: In that last 5 days, has your child tested positive for COVID-19 on a rapid antigen test or home-based self-testing kit? *

Yes - your child must stay home and isolate for at least 5 days and are symptom-free for 24 hours

QUESTION 5: Has your child been identified as a “close contact” of someone who currently has COVID-19 and been advised to self-isolate? *

Yes

QUESTION 6: Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)? *

Yes

QUESTION 7: Check the following that apply: *

In the last 14 days, the student/child travelled outside of Canada and was told to quarantine

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

In the last 14 days, someone the student/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 apply to my child

Required

If you answered "YES" to any of the questions above, your child should stay home and not attend school. Please refer to the Covid-19 Preparedness and Response Plan for next steps.

Any additional notes about your childs' well being?

I, the parent/caregiver, of the child listed above authorize that the information provided in this form is truthful and accurate to the best of my knowledge. *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms