Child Online Screening Form

Child Screening

Child Information

Screening Questions

1. In the last 5 days (If the student/child is fully vaccinated OR 11 years old or younger) or 10 days (If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised) has the student/child experienced any of these symptoms?

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 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 the student/child is symptomatic and has tested negative for COVID-19 on a single PCR test or two rapid antigen tests (RAT) taken 24 hours apart, and symptoms have been improving for 24 hours, you may answer “no” to all symptoms.

Choose any/all that are new, worsening, and not related to other known causes or conditions they already have.

Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills
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)
Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have)
Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have
2. In the last 5 days (If the student/child is fully vaccinated OR 11 years old or younger) or 10 days (If the student/child is 12 years of age or older and not fully vaccinated OR if they are immune compromised) has the student/child experienced any of these symptoms?

Choose any/all that are new, worsening, and not related to other known causes or conditions they already have.

Painful swallowing (not related to seasonal allergies, acid reflux, or other known causes or conditions you already have)
Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have
Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have) If the student/child received a COVID-19 and/or flu vaccination in the last 48 hours and is experiencing a mild headache that only began after vaccination, select “No.”
Unusual, fatigue, lack of energy, poor feeding in infants (not related to depression, insomnia, thyroid disfunction, sudden injury, or other known causes or conditions they already have) If the student/child received a COVID-19 and/or flu vaccination in the last 48 hours and is experiencing mild fatigue and/or mild muscle aches/joint pain that only began after vaccination, select “No.”
If the student/child received a COVID-19 and/or flu vaccination in the last 48 hours and is experiencing mild fatigue and/or mild muscle aches/joint pain that only began after vaccination, select “No.”
Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have
This includes a positive COVID-19 test result on a lab-based PCR test, rapid antigen test or home-based self-testing kit.
If the individual isolating has not tested positive for COVID-19 and only has one of these symptoms: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, extreme tiredness, muscle aches or joint pain, nausea, vomiting and/or diarrhea, select “No.”
If public health guidance provided to you has advised you that you do not need to self-isolate, select “No.”
This can be because of an outbreak or contact tracing.
Please note that if the child/student is not fully vaccinated but is exempt from federal quarantine because they travelled with a vaccinated companion, they must not attend school or child care for 14 days. Select “yes” if this applies to the student/child.

These Instructions show if you answered “YES” to any of the symptoms:

Results of screening questions

If you answered “YES” to ANY question, your child cannot go to school or child care. Contact your school/child care provider to let them know that your child will not be attending school today.

See below for isolation and testing requirements

NOTE: When the option of [5, 10] days is listed:

  • If the student/child is fully vaccinated OR 11 years old or younger, use 5 days
  • If the student/child is 12 years old or older AND is not fully vaccinated OR is immune compromised, use 10 days

If you answered “YES” to any of the symptoms listed under question 1, do not go to school
or child care.

  • The student/child must isolate (stay home) and not leave except to get tested or for a
    medical emergency.
  • If the student/child is not tested, and if:
    • The student/child is fully vaccinated OR 11 years old or younger they must isolate for 5 days from when symptoms started and stay in isolation until their symptoms have been improving for 24 hours (or 48 hours after nausea, vomiting and/or diarrhea symptoms), whichever is longest.
    • The student/child is 12 years old or older and not fully vaccinated OR is immune compromised they must isolate for 10 days from when the symptoms started and stay in isolation until their symptoms have been improving for 24 hours (or 48 hours after nausea, vomiting and/or diarrhea symptoms), whichever is longest.
  • If testing is available:
    • If a single PCR test or rapid antigen test (RAT) is positive, the student/child should follow the guidance above “if the student/child is not tested”
    • If a single PCR test is negative or two rapid antigen tests (RATs) collected 24-48 hours apart
      are both negative, the student/child may return to school/child care when their symptom(s) have been improving for 24 hours (48 hours for nausea, vomiting and/or diarrhea).
  • Household members, including siblings, must stay home at the same time as the student/child, whether they are fully vaccinated or not.

If you answered “YES” to any of the symptoms listed under question 2, do not go to school or child care.

  • If the student/child has experienced only one of these symptoms in the last [5, 10] days the student/child must stay home until the symptom has been improving for at least 24 hours
    (48 hours for nausea, vomiting and/or diarrhea).
  • If the student/child has experienced two or more of these symptoms in the last [5, 10] days the student/child must stay home.
    • If the student/child is not tested and:
      • The student/child is fully vaccinated OR 11 years old or younger they must isolate for
        5 days from when symptoms started and stay in isolation until their symptoms have
        been improving for 24 hours (48 hours for nausea, vomiting and/or diarrhea),
        whichever is longest.
      • The student/child is 12 years old or older and not fully vaccinated OR is immune compromised they must isolate for 10 days from when the symptoms started and stay in isolation until their symptoms have been improving for 24 hours (48 hours for nausea, vomiting and/or diarrhea), whichever is longest.
  • If testing is available:
    • If a single PCR test or a rapid antigen test is positive, the student/child should follow the guidance above, “if the student/child is not tested”
    • If a single PCR test or two rapid antigen tests (RATs) collected 24-48 hours apart are both negative, the student/child may return to school/child care when their symptoms have
      been improving for at least 24 hours (48 hours for nausea, vomiting and/or diarrhea).
  • Household members, including siblings, must stay home at the same time as the student/child, whether they are fully vaccinated or not.

NOTE: If the student/child also answered “YES” to question 1, follow question 1 guidance
for next steps, including testing, if available.

If you answered “YES” to question 3, do not go to school or child care

  • The student/child must isolate (stay home) and only leave for a medical emergency.
  • If the student/child is fully vaccinated OR 11 years old or younger they must isolate for 5 days from when symptoms started or from when they tested positive for COVID-19 (whichever was first) and stay in isolation until their symptoms have been improving for 24 hours (or 48 hours
    after nausea, vomiting and/or diarrhea symptoms), whichever is longest.
  • If the student/child is 12 years old or older and not fully vaccinated OR is immune compromised they must isolate for 10 days from when the symptoms started or from when they tested positive for COVID-19 (whichever was first) and stay in isolation until their symptoms have been improving for 24 hours (or 48 hours after nausea, vomiting and/or diarrhea symptoms), whichever is longest.
  • Household members, including siblings, must stay home at the same time as the student/child, whether they are fully vaccinated or not.

If you answered “YES” to question 4, do not go to school or child care.

  • The student/child must isolate (stay home) while there is anyone in the home who is isolating because of symptoms, a positive COVID-19 result or is waiting for a COVID-19 test result. The student/child should only leave home for a medical emergency.
  • All household members must stay home at the same time as the household member who has COVID-19 symptoms or is a positive COVID-19 case, whether they are fully vaccinated or not.

If you answered “YES” to question 5 or 6, do not go to school or child care.

  • The student/child must isolate (stay home) and not leave except to get tested or for a medical emergency.
  • If the student/child develops symptoms, follow isolation guidance found under results to “If you answered “YES” to any of the symptoms listed under question 1 do not go to school or child care.” and/or “If you answered “YES” to any of the symptoms listed under question 2, do not go to school or child care” depending on the symptoms the student/child is experiencing.
  • If the student/child is isolating because they were identified as a close contact of someone
    who currently has COVID-19 and advised to isolate, or because of an outbreak or contact
    tracing, siblings or other people in the household can go to school, child care or work,
    but must not leave the home for other, non-essential reasons.

If you answered “YES” to question 7, do not go to school or child care.

  • The student/child must follow federal guidelines for individuals who have travelled internationally, including not going to school/child care for 14 days after their arrival and
    getting tested as per federal requirements.
  • If the student/child has been directed to quarantine, they must stay home for 14 days and not leave except to get tested or for a medical emergency. For more information on federal requirements for travellers, please see the Government of Canada’s website.
  • If someone the student/child lives with is isolating following return from travelling outside of Canada and received a take-home PCR test at the airport, is symptomatic following international travel OR is awaiting test results, the student must stay home until the individual has received a negative PCR test result.
  • If the student/child develops symptoms, follow isolation guidance found under results to “If you answered “YES” to any of the symptoms listed under question 1 do not go to school or child care.” and/or “If you answered “YES” to any of the symptoms listed under question 2, do not go to school or child care” depending on the symptoms the student/child is experiencing.

These Instructions show if you answered “NO” to all questions:

If you answered “NO” to all questions, your child may go to school/child care. Follow your school/child care provider’s established process for letting staff know about this result.

  • As per regular protocols, all sick individuals with any symptoms of illness should stay home and seek assessment from their regular health care provider if required.
  • Individuals with severe symptoms requiring emergency care should go to their nearest emergency department.
  • If an individual develops symptoms outside of the list above, the local public health unit may recommend other measures, including testing based on an assessment of the individual’s symptoms and exposure history.
The Ministry of Education, together with the Chief Medical Officer of Health, has declared that if you have answered yes to any of the above, you are not permitted to enter the childcare setting. Please call your campus supervisor or the Windsor Essex County Health Unit for assistance with next steps.

Parent/Guardian Contact Information

By checking the box below, I hereby declare that:
The information provided is to the best of my knowledge accurate, truthful
& correct in all respects, and I have not omitted to disclose any information. *