COVID-19 Active Screening Form
*To be completed daily for each household (1 form for each child)
Instructions: These screening questions apply to everyone in the household and to child(ren) in child care. Temperature recordings are only required for those entering or residing in the home child care residence.
If YES was answered for any of the questions for the child attending childcare or any household member (parents/guardians, siblings), the Provider may not permit them to enter the centre.
Close contact is being coughed or sneezed on or within 2 meters of an individual with COVID-19 symptoms for 15 minutes.
*Other Symptoms Include:
Sore throat, Difficulty swallowing, Pink eye (conjunctivitis), Nasal congestion or runny nose without other known cause, Rash (if a child), Croup (respiratory infection resulting in barking cough and difficulty breathing) (if a child), Unexplained fatigue/malaise/muscle aches, Diarrhea, Nausea/vomiting, Decrease or loss of sense of taste or smell, Chills, Headaches or Abdominal pain.
Thanks for submitting the daily COVID-19 Active Screening Form for Households