Licensed Child Care Daily COVID-19 Health Screening

An enhanced screening process must be completed daily in licensed child care settings, as per Ministry of Health direction.

The responses you provide will be used to determine your child’s eligibility to enter the centre on the current day. The health of children, families, and employees is our top priority; we thank you for your accuracy in completing this screening tool.

Daily Self-Assessment form for Child Care centre employees:

COVID-19 Questionnaire

If you already went for a test and got a negative result, select “No.”

Are you currently experiencing any of the following new or worsening symptoms?

  • Fever and/or chills (a fever is a temperature of 37.8ºC/100ºF or higher)
  • Cough (continuous, more than usual), including croup. Croup is often a barking cough and whistling noise when breathing). Not related to other causes such as asthma or reactive airway
  • Shortness of breath (out of breath, unable to breathe deeply). Not related to other causes such as asthma
  • Sore throat. Not related to known causes such as seasonal allergies or acid reflux
  • Difficulty swallowing (painful swallowing). Not related to known causes
  • Decrease or loss of smell or taste. New and not related to other causes such as nasal polyps, allergies, neurological disorders
  • Runny or stuffy/congested nose. Not related to known causes such as seasonal allergies or being outside in the cold weather
  • Pink eye (conjunctivitis). Not related to known causes such as recurring styes.
  • Headache that is unusual or long-lasting. Not related to known causes such as tension-type headaches or chronic migraines
  • Digestive issues (nausea/vomiting, diarrhea or stomach pain). Not related to known causes such as irritable bowel syndrome or menstrual cramps
  • Muscle aches that are unusual or long lasting. Not related to known causes such as sudden injury or fibromyalgia
  • Extreme tiredness that is unusual (fatigue, lack of energy). Not related to known causes such as depression, insomnia, thyroid dysfunction
  • Falling down often. Mainly a concern for older people

Acknowledgement and Submission

YMCA of Niagara Privacy Statement: As a charitable, community based association, the YMCA of Niagara is committed to protecting your right to privacy. The personal information you share with us will be used to support the work of the YMCA. For further information, please visit ymcaofniagara.org