LWS Faculty Licensed Care Daily Screening Tool
To be completed each day prior to or upon arrival at school by all staff members working in the Licensed Care Program.
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First and last name of person completing this form: *
Instructions
It is a licensed care requirement that all staff working in the Licensed Care programs answer the following questions each day.

Upon arrival at the screening station your screening record will be verified or can be completed at that time.

Do you have any of the following new or worsening symptoms or signs? (Symptoms should not be chronic or related to other known causes or conditions.) *
YES
NO
Fever and/or chills (temperature of 37.8°C/100.0°F or greater)
Cough
Sore throat, trouble swallowing
Runny nose/stuffy nose or nasal congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
3. Have you travelled outside of Canada in the past 14 days? *
3. Have you had close contact with a confirmed or probable case of COVID-19? *
Have you or your child been directed by a health care provider (including public health officials) to isolate? *
Results of Screening Questions
• If the individual answers NO to all questions from 1 through 3, they have passed and can
enter the workplace.

• If the individual answers YES to any questions from 1 through 3, they have not passed and
should be advised that they should not enter the workplace (including any outdoor, or
partially outdoor, workplaces). They should go home to self-isolate immediately and
contact their health care provider or Telehealth Ontario (1 866-797-0000)to find out if they
need a COVID-19 test
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