Health requirements for child care staff

Under the Child Care and Early Years Act, each person working, volunteering, or living in a child care centre must complete a health assessment recommended by the local medical officer of health.

In Peel, the direction from the Medical Officer of Health is that a Tuberculosis (TB) assessment, completed by a doctor or nurse practitioner, is required for anyone working, volunteering, or living in a child care centre. This is to ensure that those entering the child care centre on a regular basis do not have active TB disease. The initial baseline TB assessment can be done from 6 months before and up to one month after starting work or placement.

Staff are not required to have a general medical examination either when beginning employment or at any later date.

Early Childhood Educator students require a TB assessment before their first placement. Assessments are not required for each subsequent placement unless the student has TB symptoms.

TB assessment includes:

• A review of signs and symptoms of TB (e.g., cough for more than 3 weeks, coughing up blood, chest pain, fatigue, fever, night sweats, unexplained weight loss, loss of appetite)
• A review for history of TB disease or infection and whether they received appropriate treatment.
• An assessment for the presence of risk factors that would increase the likelihood a person would develop active TB in future (e.g., diseases or treatment that compromise the immune system or contact with someone with infectious TB).
• Determination of the need for baseline or repeat TB testing, which may include TB skin test or chest x-ray.

Additional assessment details:

• If the person has no previous documented skin test, a one-step skin test is required. A blood test called Interferon Gamma Release Assay (IGRA) is also an accepted TB test.
• If there is documentation of a previous skin test or IGRA, and the result was negative, repeat testing is not required unless the individual has TB symptoms or new risk factors have been identified.
• If someone had a previous positive TB skin test or IGRA, or had TB disease, they should not be tested for TB infection by TST or IGRA.
• If someone had a previous positive TB skin test or IGRA, and they don’t have any symptoms or new risk factors, then the physician may not require a chest x-ray or sputum test.
• If the current TST or IGRA result is positive, a chest x-ray and possibly a sputum test are required to rule out infectious TB.

Annual or regular skin tests or chest x-rays for TB are not required for staff, volunteers or students. In the event there is a case of TB in the child care centre, the health department in collaboration with the centre, will determine who might be at risk and what follow up is required.

If TB disease is ruled out, a person with a positive skin test or IGRA result may work and go about their activities of daily living without restrictions.

Documentation stating the individual was assessed for TB and is cleared for work or placement should be provided to the child care provider; do not forward to Peel Public Health.

Under the Child Care and Early Years Act, each person working, volunteering, or living in a child care centre must be vaccinated according to the recommendations made by the local medical officer of health. The operator must collect and maintain the information on file at the facility.

Peel Public Health requires these vaccines.

Tetanus, Diphtheria and Pertussis

A single dose of Tdap vaccine received as an adult (18 years of age and over). Then, Td vaccine booster every 10 years.

Measles, Mumps, Rubella

A series of 2 doses of MMR vaccine for adults born in or after 1970, or evidence of immunity by blood test. Adults born before 1970 are considered immune.

Hepatitis B

A series of 2 or 3 doses depending on the vaccine product given, or proof of immunity by blood test.

Varicella (chickenpox)

A series of 2 doses or proof of immunity (self-reported history of chickenpox before 2004 or a blood test).

Hepatitis A, Meningococcal

Vaccination is recommended for those notified by public health that they have been exposed to someone who has the disease.

COVID-19 and Flu

Staying up to date with your COVID-19 vaccines and your annual flu shot is strongly encouraged. Proof of vaccination is not required.

In addition to the list above, you may be eligible for other vaccines for adults depending on your age. Contact your health care provider to determine your immunization status and to obtain any missing vaccines.

You will need to download and complete one of the following forms:

• A statement of medical exemption form must be completed and signed by a physician or nurse practitioner.
• A statement of conscience or religious belief form must be signed by a commissioner for taking affidavits in Ontario.

You may not be able to download these forms using a mobile device.

Staff must return the original, completed, and signed documents to the child care centre operator. For more information on exemptions, please call Peel Public Health at 905-799-7700.

In the case of an outbreak at the child care centre, staff with an exemption (or incomplete immunization records) may be at risk for infection and therefore may be excluded from working in the child care centre until the outbreak is over at the direction of public health. This is to protect the health and safety of the unvaccinated worker.