All About Kids COVID Screening Questionnaire

Please complete the following screening form for each child that will be attending All About Kids. This form must be submitted prior to drop-off each day. Each child must pass an on-site temperature test before entry.

Anyone who is sick or has any symptoms of illness, including those not listed under COVID-19 symptoms, should stay home and seek assessment from their health care provider if needed.

All About Kids Daily Child Screening

1Parent & Child Info

2Symptom Screening

3Health & Wellness Screening

4Exposure Screening

5Consent

Parents Name*
First Last
Parents Cell:*
Parents Email:*
Child's Name*
First Last
Which All About Kids location is your child attending?*
Which program is your child is attending?*
Which program is your child is attending?*
Which program is your child is attending?*
Which program is your child is attending?*

Screening Checklist
In the last (5/10) days has the child experienced any of these symptoms (new, worsening and not related to other known causes/conditions)? Select NO, if all apply: the child completed his/her isolation of 5/10 days, the child tested negative on one PCR test or rapid molecular test or 2 RAT taken 24-48 hours apart and symptoms have been improving for 24 hours (48 hours for nausea, vomiting and/or diarrhea).
In the last (5/10) days has the child experienced any of these symptoms (new, worsening and not related to other known causes/conditions)? Select NO, if all apply: the child completed his/her isolation of 5/10 days OR the child tested negative for COVID-19 on one PCR test or rapid molecular test or 2 RAT taken 24-48 hours apart AND does not have a fever AND symptoms have been improving for 24 hours (48 hours for nausea, vomiting and/or diarrhea).
Fever and/or chills*
Temperature of 37.8C/100.0F or greater
- No
- Yes
Do NOT go to childcare. • The child must isolate (stay home) and not leave except to get tested or for a medical emergency. If the child is not tested, and if: • The 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. Please notify your centre Supervisor for further instruction.
Cough*
More than usual if chronic cough including croup, barking cough, making a whistling noise when breathing and not related to other known causes/conditions such as asthma or reactive airway.
- No
- Yes
Do NOT go to childcare. • The child must isolate (stay home) and not leave except to get tested or for a medical emergency. If the child is not tested, and if: • The 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. Please notify your centre Supervisor for further instruction.
Difficulty Breathing*
Such as dyspnea, out of breath, unable to breathe deeply, wheeze, that is worse than usual if chronically short breath (not related to other known causes/conditions such as asthma.
- No
- Yes
Do NOT go to childcare. • The child must isolate (stay home) and not leave except to get tested or for a medical emergency. If the child is not tested, and if: • The 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. Please notify your centre Supervisor for further instruction.
Decrease or Loss of Smell or Taste*
New olfactory or taste disorder and not related to other known causes/conditions such as polyps, allergies or neurological disorders.
- No
- Yes
Do NOT go to childcare. • The child must isolate (stay home) and not leave except to get tested or for a medical emergency. If the child is not tested, and if: • The 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. Please notify your centre Supervisor for further instruction.
Please indicate when the 5 day-isolation or 10-day isolation period was completed.*

allaboutkids.ca | info@allaboutkids.ca

All About Kids Daily Child Screening

Screening Checklist