Appendix A: Screening Tool for Children/Staff/Visitors

This checklist must be completed each day. If you are unsure or have questions, contact 811 prior to attending child care.

Todays Date:
Name :
I have read and understand CRLC Pandemic Policy and ProceduresYESNO
I consent to a temperature check (please provide temperature here _____________________)YES NO
PLEASE ANSWER THE FOLLOWING QUESTIONS
Are you , your child or anyone in your home unwell?YESNO
Do you , your child or anyone in your home have any of the following symptoms.
– Fever (or chills or sweats)?YESNO
– New or worsening of a previous cough?YESNO
– Sore throat?YESNO
– Headache?YESNO
– Shortness of Breath?YESNO
– Muscle Aches?YESNO
– New or worsening sneezing?YESNO
– New or worsening nasal congestion or runny nose?YESNO
– Hoarse voice?YESNO
– Diarrhea?YESNO
– Unusual fatigue?YESNO
– Loss of sense of smell or taste?YESNO
Red, purple or blueish lesions (spots) on the feet, toes or fingers, without clear cause?YESNO
In the past 14 days, have you, your child or anyone in your home travelled outside of Nova Scotia?YESNO
In the last 14 days, have you, your child or anyone in your home had close contact (within 2 metres / 6 feet) with someone confirmed to have COVID-19 infection?YESNO
Are you, your child or anyone in your home awaiting results from a COVID-19 test?YESNO

If you answer YES to any one of these questions, your child is not able to attend child care.Inform your child care provider of the reason for your child’s absence.

If you answered YES in Question 1 or 2, or if you have any questions, contact 811.

A child with chronic stable cough, sneeze, runny nose, or nasal congestion that is unchanged and clearly linked to a known medical condition such as asthma or allergies may still be able to attend child care.

Changing or worsening of chronic symptoms requires isolation and contacting 811.

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