Child Online Screening Form

Child Screening

Child Information

Screening Questions - Section 1

1. Is the student/child currently experiencing any of these symptoms?

The symptoms listed here are the symptoms most commonly associated with COVID-19. Our guidelines for children and adults continue to evolve as we learn more about COVID-19, how it spreads, and how it affects people in different ways.

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
Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have
If YES, skip questions 3, 4, 5.
If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”
If public health has advised you that you do not need to self-isolate, select “No.”
If they already went for a test and got a negative result, select “No.”
If travel was solely due to a cross border custody arrangement, select “No.”
This can be because of an outbreak or contact tracing.
If the student/child has since tested negative on a lab-based PCR test, select “No.”

These Instructions show if you answered “YES” to any of the symptoms included under question 1:

If you answered “YES” to any of the symptoms included 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.
  • Talk with a doctor/health care provider to get advice or an assessment, including if the student/child needs a COVID-19 test.
    • Siblings or other people in your household must stay at home until the student/child showing symptoms tests negative, or is cleared by your public health unit, or is diagnosed with another illness. Household members who are fully vaccinated or previously positive for COVID-19 in the last 90 days and have since been cleared are not required to stay home.
  • Contact your school/child care provider to let them know about this result.

These Instructions show if you answered “YES” to question 3:

If you answered “YES” to question 3, 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.
  • The student/child can return to school or child care after the individual with symptoms tests negative, is cleared by your local public health unit, or is diagnosed with another illness.
  • Contact your school/child care provider to let them know about this result.

These Instructions show if you answered “YES” to question 4:

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

    The student/child must isolate (stay home) for 10 days and not leave except to
    get tested or for a medical emergency.

  • Talk with a doctor/health care provider to get advice or an assessment, including if they
    need a COVID-19 test. The student/child can only return to school/child care after 10 days,
    even if they get a negative test result, as long as they do not develop any symptoms.

    • Siblings and other people in your household can go to school, child care or work, but must
      not leave the home for other non-essential reasons. Household members who are fully vaccinated or previously positive for COVID-19 in the last 90 days and have since been cleared are not required to stay home.
  • If the student/child develops symptoms or tests positive, contact your local public health
    unit or doctor/health care provider for more advice.
  • Contact your school/child care provider to let them know about this result.

These Instructions show if you answered “YES” to question 5:

If you answered “YES” to question 5, 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.
  • Visit an assessment centre to get them a COVID-19 test.
    • If they test negative (they do not have the virus), they can return to school/child care.
    • If they test positive (they have the virus), they need to continue isolating and can return only after they are cleared by your local public health unit.
  • If they develop symptoms, contact your local public health unit or doctor/health care provider
    for more advice.

    • Siblings or other people in your household can go to school, child care or work, but must not leave the home for other, non-essential reasons until the individual who got the COVID alert tests negative, or is cleared by your local public health unit. Household members who are fully vaccinated or previously positive for COVID-19 in the last 90 days and have since been cleared are not required to stay home.
  • Contact your school/child care provider to let them know about this result.

These Instructions show if you answered “YES” to question 6:

If you answered “YES” to question 6, 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 the student/child develops symptoms and/or tests positive, contact your local public health unit or doctor/health care provider for more advice.
  • Contact your school/child care provider to let them know about this result.

These Instructions show if you answered “YES” to question 7:

If you answered “YES” to question 7, 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.
  • Follow the advice of public health. The student/child can return to school/child care after
    they are cleared by your local public health unit.
  • If the student/child develops symptoms, contact your local public health unit or
    doctor/health care provider for more advice.

    • Siblings or other people in your household must stay at home until the student/child
      tests negative, or is cleared by your public health unit. Household members who are fully vaccinated or previously positive for COVID-19 in the last 90 days and have since been
      cleared are not required to stay home.
  • Contact your school/child care provider to let them know about this result.

These Instructions show if you answered “YES” to question 8:

If you answered “YES” to question 8, 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.
  • Visit an assessment centre to get them a COVID-19 test.
    • If they test negative (they do not have the virus), they can return to school/child care.
    • If they test positive (they have the virus), they need to continue isolating and can return
      only after they are cleared by your local public health unit.
  • If they develop symptoms, contact your local public health unit or doctor/health care provider
    for more advice.
  • Siblings or other people in your household must isolate until the individual who tested positive on the rapid antigen test or home-based self-testing kit tests negative on a PCR test or is
    cleared by the local public health unit. Household members who are fully vaccinated or previously positive for COVID-19 in the last 90 days and have since been cleared are not
    required to isolate.
  • Contact your school/child care provider to let them know about this result

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 Public Health Unit may recommend other measures including testing based on an assessment of the individual’s symptoms and exposure history.

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. *