COVID-19 Active Surveillance Form
Glenashton Daycare Centre
1. Are you, your child or a family member experiencing fever or chills, cough, shortness of breath, decreased or loss of taste or smell?

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.

2. Two or more of the following symptoms: • Runny nose or nasal congestion • Headache • Extreme fatigue • Sore throat • Muscle aches or joint pain • Gastrointestinal symptoms (such as vomiting or diarrhea)
3. In the last 10 days, has someone you live with: been sick with symptoms associated with COVID-19? and/or tested positive for COVID-19 (on a rapid antigen test or PCR test)?
4. In the last 10 days have you been notified as a close contact of someone with Covid-19 or received a Covid Alert notification?
5. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?
6. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?
7. Have you given or taken any fever reducing medications in the last 5 hours?
8. DO YOU live with someone who is currently isolating due to waiting for Covid-19 results, showing symptoms of covid-19 or have tested positive for COVID-19?

Thanks for submitting!

COVID-19 Screening Results
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