Private Home Child Care COVID-19 Screening Tool

NOTE: This tool is for Private Home Child Care Providers only. It must be completed daily, a minimum of 1 hour prior to opening.

Please complete all questions and submit your results. Once submitted, an email will be sent to the email address provided in the tool below and the supervisor of Private Home Child Care. Thank you for your co-operation.

Do you 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

Do a member of your household 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

Personal information is collected for the purpose of complying with provincial orders related to the COVID-19 pandemic, 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: Carla Aiken.



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