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OFFICES

Windsor Office
1005 Ouellette Avenue
Windsor, ON N9A 4J8
Ph: (519) 258-2146

Leamington Office
33 Princess Street
Leamington, ON N8H 5C5
Ph: (519) 326-5716

Search form

Search form

OFFICES

Windsor Office
1005 Ouellette Ave.
Windsor, ON
N9A 4J8
Ph: (519) 258-2146

Leamington Office
33 Princess St.
Leamington, ON
N8H 5C5
Ph: (519) 326-5716

For Professionals
Childcare Providers
School and Childcare Centre Absenteeism Reporting Form

School and Childcare Centre Absenteeism Reporting Form

Main Page Content

Contact Information

School/Childcare Centre Name *

Your Full Name *

Your Email Address *

Your Title/Position *

Phone Number *

Extension

Absenteeism Information

Is absenteeism ≥ 20% or is there an illness concern within a cluster? *

Yes

No

Date of Absenteeism *

Year

Month

Day

Student Information

Number of Ill Students *

Total Students in School/Centre *

Grades/Rooms of Ill Students

Please select all applicable grades of ill students.

Infant

Toddler

Preschool

Before/After School

JK

SK

1

2

3

4

5

6

7

8

9

10

11

12

Entire School/Childcare Centre

Other

Other (please specify)

Staff Information

Number of Ill Staff *

Total Staff in School/Centre *

Symptoms

Presenting Symptoms *

Please select all applicable symptoms. If 'other' is selected, please specify in the field below.

Nausea

Vomiting

Diarrhea

Fever

Cough

Runny Nose

Sore Throat

Other

Other Details

Additional Details

Recent school/centre activities or events

Is food service offered on-site? *

Yes

No

Please Submit this form to let us know absenteeism is now below 10%.

Leave this field blank

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Offices

Windsor Office
1005 Ouellette Avenue
Windsor, ON N9A 4J8
Ph: (519) 258-2146

Leamington Office
33 Princess Street
Leamington, ON N8H 5C5
Ph: (519) 326-5716