Before entering a child care program, employees, volunteers, parents, children and essential visitors must complete a health screening questionnaire daily. In addition, each employee, volunteer, parent, child and essential visitor must sign and submit this form to the program one time . Employees, volunteers, parents, children and essential visitors must answer all questions and take their temperature daily to confirm a body temperature lower than 100.0 degrees Fahrenheit. If anyone answers “Yes” to any of the questions below, they cannot enter the child care program. A parent or guardian is responsible for completing daily screening on behalf of their child(ren).
Below are the self-screening questions that employees, volunteers, parents, children and essential visitors are required to answer daily . If any of the answers to the below questions are “Yes,” individuals cannot enter the program. If the answers are “No” to all the following questions, individuals may enter the program. If employees, volunteers, parents, children and essential visitors cannot take their temperature at home, but answer “No” to all other questions, they may report to the program to have their temperature taken on site.
- Is your temperature higher than or equal to 100.0 degrees Fahrenheit?
- Have you had any known contact with a person confirmed or suspected to have COVID-19 in the past 14
- Are you currently experiencing ANY of the following symptoms?
Have you tested positive for COVID-19 through a diagnostic test in the past 14 days?
- Cough (new or worsening)
- Shortness of breath (new or worsening)
- Trouble breathing (new or worsening)
- Muscle pain (new or worsening)
- Headache (new or worsening)
- Sore throat (new or worsening)
- New loss of taste
- New loss of smell
If you have answered “NO” to all questions, you have passed and may enter the program.
If you have answered “YES” to any question, you will not be allowed to enter the program.
Attestation: By signing this document, I agree that I will self-monitor these symptoms each day and report the
outcome per the instructions above and will not enter any child care program if any of the above symptoms or
conditions are present.