CCC Screening Protocol

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

Daily Screening Protocol for Campus Children's Centre

Please note that CCC still requires families and children that tested positive for COVID-19 to refrain from attending the centre until at least 5 days have past and symptoms have improved.

Updated on March 14, 2022, from the Government of Manitoba COVID-19 Screening Questions.

Which side does your child(ren) attend? *

15 Side

19 Side

Both

Child(ren)'s First and Last Name *

Parent/Guardian's Name *

Email Address *

Primary Symptoms

Please indicate if your child, or anyone in your household, has any of the following symptoms.

IF ANYONE IN YOUR HOUSEHOLD HAS ANY OF THESE SYMPTOMS, YOUR CHILD MAY NOT ATTEND CCC. THIS INCLUDES SIBLINGS.

You should contact your doctor or Manitoba HealthLinks - Info Sante at 204-788-8200 to determine if you should get tested for COVID-19.

Fever of over 38 C? *

Yes

Cough *

Yes

Sore Throat or Hoarse Voice *

Yes

Shortness of Breath / Breathing Difficulties *

Yes

Loss of Taste or Smell *

Yes

Vomiting or Diarrhea for more than 24 Hours *

Yes

Secondary Symptoms: Does anyone in your household have the following symptoms? If TWO or MORE, they cannot attend Campus Children's Centre. *

Runny Nose

Muscle Aches

Fatigue

Conjunctivitis (Pink Eye)

Headache

Skin Rash of Unknown Cause

Nausea or Loss of Appetite

Poor Feeding (if an infant)

None of the Above

Required

Any additional comments with regards to symptoms? (ie, if Runny Nose, then 'Clear discharge and no other symptoms')

Is there any person in your household currently suffering from ANY of the symptoms listed above? *

Yes

Change to Close Contact protocol in childcare setting

On January 28, 2022, Manitoba Public Health guidelines changed, so that children who are exposed to COVID-19 in a childcare setting can still attend, if they are ASYMPTOMATIC.

Have you, or anyone in your household, been in close contact (within 2 metres/6 feet for more than 10 minutes total over 24 hours) in the last 7 days with a confirmed case of COVID-19, outside of a childcare setting? *

Yes

Have you, or anyone in your household, travelled outside of Manitoba within the past 14 days and are required to self isolate (quarantine)? *

Yes

Are you, or any member of your household, waiting for COVID-19 test results? *

Yes

Have you, or anyone in your household, tested positive - with a rapid antigen test or a laboratory based test - in the past 10 days? *

Yes

"I declare that I have answered these questions truthfully and 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