COVID-19 Screening Form
We are following the Center for Disease Control (CDC) and Washington Health Department guidelines to protect the public, as well as our employees, from the COVID-19 pandemic. To this extent, all individuals (staff and visitors) entering the building must be asked the following questions:
Your Name: *
Email: *
Childs name: *
I confirm that I am not presenting any of these COVID-19 symptoms: Fever or chills, shortness of breath, cough, runny nose or congestions, sore throat, fatigue, muscle or body aches, headache, new loss of taste or smell, nausea or vomiting, diarrhea. *
Required
I confirm that I have not been in contact with a person who has been diagnosed with COVID-19 within the past 14 days. *
Required
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. The CDC recommends social distancing of at least six feet for a period of 14 days for anyone who has recently traveled. *
Required
I verify that I have not traveled outside of the United States within the past 14 days. *
Required
I verify that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days. *
Required
Please Note: Prior to the child's entry into a child care center, temperature reading will be taken by a staff member and children must wash their hands using hand sanitizer or hand washing at the sink.
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