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Required Covid-19 Screening
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West Nipissing Child Care Corporation
Required Covid-19 Screening
Home
Required Covid-19 Screening
Dear parents, guardians, employees, providers and students.
Please note that the self-screening tool has been modified.
Therefore it is very important that it be used daily.
The North Bay-Parry Sound District Health Unit has updated its “Schools/Child Care and COVID-19” information page
here.
Please answer the following questions: Check the appropriate box. Thank you.
1. I am taking this screening as a:
*
Student/Child
Parent/Guardian on behalf of a student/child
Employee-Provider
Essential Visitor
2. In the last 14 days, have you or anyone you live with travelled outside of Canada?
*
Yes
No
3. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
*
Yes
No
4. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?
*
Yes
No
5. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
*
Yes
No
6. Are you currently experiencing any of these symptoms?
*
Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup)
Shortness of breath
Decrease or loss of taste or smell
Sore throat
Difficulty swallowing
Runny nose or stuffy/congested nose
Pink eye
Headache
Digestive issues like nausea/vomiting, diarrhea, stomach pain
Muscle aches
Extreme fatigue
Falling down often
None of the above
7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
*
Yes
No
If you have answered yes to any of the above questions or have refused to answer:
Your child will not be permitted to attend the child care center.
Please indicate which child care your child attends.
*
La tanière des tout-petits
Service de garde des louveteaux
La niche des lionceaux
Centre-based
White Woods
La ruche des petites abeilles
EarlyON
Not applicable
Comments
By submitting this form I certify that the above statements are true and valid.
Name
*
First
Date
*
Date Format: MM slash DD slash YYYY
Phone
*
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