Child Care COVID-19 Screening Tool for Attendees

If you are staff or a worker going to the child care program, please use the COVID Pre-screening Tool for workers. If you are a Private Home Child Care Provider, please use the COVID Pre-screening Tool for Providers.

*** NOTE: If fever reducing medication was given 24 hours prior to attending, entrance will not be allowed. ***

Please complete all questions and submit your results. Once submitted, an email will be sent to the email address provided in the tool below. This email must be shown prior to entering the child care program. If you do not show the email, you will be asked to fill in the form again and show the email at that time. Thank you for your co-operation.

Each child will need their own form completed.

Does your child attending child care have any of the following new or worsening symptoms?
Symptoms should not be chronic or related to other known causes or conditions

  • Fever and/or chills (37.8 C/100 F or greater)
  • Cough, including croup (barking cough, whistling noise when breathing)
  • Shortness of breath (dyspnea, out of breath, unable to breath deeply)
  • Decrease or loss of smell or taste
  • Sore Throat (painful or difficulty swallowing)
  • Stuffy and/or runny nose (nasal congestion and/or rhinorrhea)
  • Headache that is new and persistent, unusual, unexplained or long lasting
  • Nausea, Vomiting,and/or Diarrhea
  • Fatigue, lethargy, muscle aches or malaise

Does a member of your household (ie. a sibling or an adult) have any of the following new or worsening symptoms?
Symptoms should not be chronic or related to other known causes or conditions

  • Fever and/or chills (37.8 C/100 F or greater)
  • Cough, including croup (barking cough, whistling noise when breathing)
  • Shortness of breath (dyspnea, out of breath, unable to breath deeply)
  • Decrease or loss of smell or taste
  • Sore Throat (painful or difficulty swallowing)
  • Stuffy and/or runny nose (nasal congestion and/or rhinorrhea)
  • Headache that is new and persistent, unusual, unexplained or long lasting
  • Nausea, Vomiting,and/or Diarrhea
  • Fatigue, lethargy, muscle aches or malaise

Any collection of personal information is made under the authority of the Ministry of Health Guidance Document: Operational Guidance During COVID-19 Outbreak - Child Care Re-Opening Version 5 (February 2021), Section 77.7 of the Health Protection and Promotion Act, R.S.O. 1990, c. H.7. and Ontario Regulation 364/20. Personal information is collected in compliance with the Personal Health Information Protection Act, and the Municipal Freedom of Information and Protection of Privacy Act.

None of your personal information will be shared, rented, sold or otherwise released to any third party without your consent. 

Any questions about this collection should be directed to: Rosanne Marinaro.



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