Centre-based Childcare COVID-19 Screening Form

Centre-based Childcare families – Please answer the following questions. If you answer yes to any one of them your child may not attend the program today. Please contact Centrepointe Childcare Services at 613-225-9678 to discuss any further action

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CB COVID-19 Screening Form

Your child full name

Your email addressa valid email

1) What is your child’s or temperature today?

2) Does your child or any person in your household have any "one" of the following new or worsening symptoms?Symptoms should not be chronic or related to other know causes or conditions.

Fever and/or chills (temperature of 37.8° C/100.0°F or higherCough 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 breath deeply (not related to asthma or other known causes or conditions they already have)Decrease or loss of smell or taste - not related to seasonal allergies, neurological disorders, or other known causes or conditions they already haveNone of the above

3) Does your child or any person in your household have any "two" of the following new or worstening symptoms?Symptoms should not be chronic or related to other know causes or conditions.

Sore throatHeadacheExtreme fatigue - unusual fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction or other known causes or conditions you already have) Runny nose/nasal congestionMuscle aches/joint pain - unexplained, unusual, or long lasting (not related to sudden injury, fibromyalgia, or other known causes or conditions).Nausea, vomiting, and/or diarrhea - not related to irritable bowel syndrome, anxiety, menstrual cramps, or other know causes or conditions you already have.None of the above

According to the Ministry of Health, if you answered yes to questions 2 and/or 3 for you or anyone in your household, it is highly likely that you/they have a COVID-19 infection.

•You must self-isolate immediately:

For at least 5 days from your symptom onset and until your symptoms have been improving for 24 hours (or 48hours if gastrointestinal symptoms) whichever is longer in duration if you are:

12 years of age or older AND fully vaccinated.
11 years old or younger, regardless of your vaccination status

For 10 days from your symptom onset if you are:

12 years of age or older AND either partially vaccinated or unvaccinated.
Immune compromised, regardless of your age

•All of your household members (regardless of their vaccination status) must self-isolate while you are self-isolating.

•If your symptoms worsen, seek advice from Telehealth (1-866-797-0000) or your health care provider.

•Notify your child care and/or workplace.

**Please note: If your child is exhibiting only one of the following new symptoms:

runny/stuffy nose,
sore throat,
Conjunctivitis (pink eye)
Headache
Extreme tiredness, lack of energy
Muscle aches and pains
GI symptoms (i.e. vomiting or diarrhea)

It is less likely that your child has COVID-19 infection.
Your child must self-isolate until symptoms are improving, without the use of fever reducing medication, for at least 24 hours (48 hours for gastrointestinal symptoms).

Your household members do not need to self-isolate.

4) In the last 14 days has anyone in your household travelled outside of Canada and been told a) to quarantine or b) not to attend school/child care?

YesNo

5) In the last 5 days has your child or anyone in your household been identified as a close contact of someone who is confirmed as having COVID-19 by your local health unit (or from the COVID Alert app if they have their own phone)?

YesNo

6) Is anyone in your household waiting for a COVID-19 test result?

YesNo

7) Has your child or anyone in your household tested positive using a "Rapid Antigen" test in the last 5 days.

YesNo

8) Has a doctor, health care provider, or public health unit told you that your child or anyone in the household should be isolating (staying at home)?

YesNo

9) Has anyone in your household taken medication due to fever in the last 5 days?

YesNo

Did you answer yes to any one of the above questions?If you answered yes, your child cannot attend childcare today. See below for your next steps. If you answered No to all the questions, your child may attend the program today.

YesNo

Next Steps:

Contact the childcare centre (613-225-9678) to let them know about this result.
Your child should isolate (stay home) and not leave except to get a COVID-19 test or for a medical emergency. Please do not attend child care and stay at home while isolating/awaiting test results. Household contacts must also isolate at home until test results are received. If the test is negative (shows your child does not have COVID-19) household contacts who are symptom-free can end their self-isolation and your child may return to child care 24 hours after symptoms have been improving without the use of fever-reducing medication. (Note that any time a child’s symptoms include vomiting or diarrhea, then the child has to be well for 48 hours before returning to school/child care.) If the test result is positive follow the instructions from Ottawa Public Health.
If your child is not eligible to be tested for COVID-19, your child may return if it has been at least 5 days since symptoms started, their symptoms are improving and they are feeling better.

Ottawa Public Health #: 613-580-6744

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