Required Covid-19 Screening – West Nipissing Child Care Corporation

Dear parents, guardians, employees, providers, students and essential visitors, you must screen every day, before attending a childcare.

Please note that the self-screening tool has been modified.

The North Bay-Parry Sound District Health Unit has updated its “Schools/Child Care and COVID-19” information page.

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?*

If you received a Covid-19 vaccination in the last 48 hours and are experiencing a mild headache, mild muscles aches/joint pain or mild fatigue that only began after vaccination select “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
Home-Based Child Care
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*

Date*

Phone*