COVID-19 Active Surveillance Form
Glenashton Daycare Centre
Are you, the child or a family member experiencing: fever, chills, cought or baking cough, shortness of breath, decrease or loss of taste or smell?
Are you, the child or a family member experiencing: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, nausea, vomiting, and/or diarrhea, extreme tiredness or muscle aches?
In the last 14 days, have you or anyone you live with travelled outside of Canada?
Have you/has the child or family member tested positive for COVID-19 or had close contact with a confirmed case of COVID-19?
Is there a person in your household who has one or more of the mentioned symptoms? or waiting for test results after experiencing symptoms?
Has a doctor, health care provider or public health told you or your child or family member to isolate?
In the last 14 days, have you, the child or family member been identified as a "close contact" of someone with COVID-19 by public health or the COVID Alert App?
Have you given or taken any fever reducing medications in the last 5 hours?

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COVID-19 Screening Results
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