Screening — Junction Day Care Centre

Daily Screening

Please fill out the below information each day PRIOR to arriving at the daycare to help us expedite the drop-off process for all families. Entry can be denied until the form is completed. Your confirmation email is your proof of submission.

Please follow the Ministry of Health recommendations as indicated on pages 4 & 5.

Ministry of Health | Ministry of Education, Updated March 16, 2022

I am screening for:

Name 1:

First Name

Last Name

Name 2:

First Name

Last Name

Name 3:

First Name

Last Name

1. In the last [5, 10] days have any of the individuals above experienced any of these symptoms?

• If you are fully vaccinated AND/OR 11 years old or younger, use 5 days • If you are 12 years old or older and not fully vaccinated OR if you are immunocompromised, use 10 days. Anyone who is sick or has any new or worsening symptoms of illness, including those not listed below, should stay home until their symptoms are improving for 24 hours (or 48 hours for nausea, vomiting, and/or diarrhea) and should seek assessment from their health care provider if needed. Household members of individuals with any of the below symptoms should stay home at the same time as the person who is sick, regardless of vaccination status. If you are symptomatic and tested negative for COVID-19 on a single PCR test or rapid molecular test, or two rapid antigen tests (RATs) taken 24-48 hours apart, you do not have a fever, and symptoms have been improving for 24 hours (or 48 hours for nausea, vomiting, and/or diarrhea), you may answer “no” to all symptoms. Choose any/all that are new, worsening, and not related to other known causes or conditions you already have. Fever and/or chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills Cough or barking cough (croup) Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have) Shortness of breath Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have) Decrease or loss of taste or smell Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have

2. In the last [5, 10] days have any of the individuals above experienced any of these symptoms?

• If you are fully vaccinated AND/OR 11 years old or younger, use 5 days • If you are 12 years old or older and not fully vaccinated OR if you are immunocompromised, use 10 days. You may select “No” to all symptoms if you tested negative for COVID-19 on a PCR test, a rapid molecular test, or two rapid antigen tests taken 24 to 48 hours apart AND you do not have a fever and your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea). Choose any/all that are new, worsening, and not related to other known causes or conditions you already have. Sore throat or difficulty swallowing Painful swallowing (not related to seasonal allergies, acid reflux, or other known causes or conditions you already have) Runny or stuffy/congested nose Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have Headache Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have). If you received a COVID-19 and/or flu vaccination in the last 48 hours and are experiencing a mild headache that only began after vaccination, select “No.” Extreme tiredness Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid disfunction, sudden injury, or other known causes or conditions you already have). If you received a COVID-19 and/or flu vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.” Muscle aches or joint pain If you received a COVID-19 and/or flu vaccination in the last 48 hours and are experiencing mild muscle aches/joint pain that only began after vaccination, select “No.” Nausea, vomiting and/or diarrhea Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have

3. In the last [5, 10] dayshave any of the individuals above tested positive for COVID-19?

This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test or home-based self-testing kit. • If you are fully vaccinated AND/OR 11 years old or younger, use 5 days • If you are 12 years old or older and not fully vaccinated OR if you are immunocompromised, use 10 days. Select “No” if you have already completed your isolation period of [5, 10] days because your symptoms started before your positive test result AND: • your symptoms have been improving for 24 hours (48 for nausea, vomiting, and/or diarrhea) AND • you do not have a fever

4. Do any of the following apply?

You live with someone who is currently isolating because of a positive COVID-19 test • You live with someone who is currently isolating because of COVID-19 symptoms (any one or more symptoms from question 1 above or any two or more symptoms from question 2 above) • You live with someone who is waiting for COVID-19 test results Select “No” if you completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test).

5. In the last [5, 10] days, have any of the individuals above been identified as a “close contact” of someone who currently has COVID-19 or has symptoms of COVID-19 (any one or more symptoms from question 1 above or any two or more symptoms from question 2 above)?

• If you are fully vaccinated AND/OR 11 years old or younger, use 5 days • If you are 12 years old or older and not fully vaccinated OR if you are immunocompromised, use 10 days Select “No” if any of the following apply: • You are fully vaccinated, not immunocompromised, and you do not live with the person who has COVID-19 • You completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test) • Contact with the person who has COVID-19 or symptoms of COVID-19 only occurred within a school or child care setting. Note: Given the multiple protective strategies in place, contacts who are only exposed at school or child care are not generally considered close contacts requiring isolation.

6. Has a doctor, health care provider, or public health unit told any of the individuals above that you should currently be isolating (staying at home)?

This can be because of an outbreak or contact tracing.

7. Do any of the following apply?

• In the last 14 days, you travelled outside of Canada and were told to quarantine. • In the last 14 days, you travelled outside of Canada and were told to not attend school/child care. • In the last 14 days, someone you live with returned from travelling outside of Canada and is isolating while awaiting results of a COVID-19 test.

Survey Completed By:

First Name

Last Name

Email:

Phone:

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Daily Screening

Junction Daycare