Daily Health Screen and Attestation

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).

Self Screening:

Below are 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 of the 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 or your child(ren)'s temperature equal to or higher than 100.0 degrees?*
Have you or your child(ren) had any known contact with a person confirmed or suspected to have COVID-19 in the past 14 days?*
Are you or your child(ren) currently experiencing ANY of the following symptoms? (check all that apply)*
Have you or your child(ren) tested positive for COVID-19 through a diagnostic test in the past 14 days?*
If you have answered NO to all questions, you have passed and may enter the program. If you answered YES to any questions, you will not be allowed into the program.*
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