Daily Health Screening
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.

Date
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Name (Child/Staff)
Is your child's temperature higher than or equal to 100.0 degrees Fahrenheit?
Have you, your child or anyone in your household had any known contact with a person confirmed or suspected to have COVID-19 in the past 14 days?
Are you, your child or anyone in your household currently experiencing ANY of the following symptoms? Cough (new or worsening), Shortness of breath (new or worsening), Trouble breathing (new or worsening), Fever, Chills, Muscle pain (new or worsening), Headache (new or worsening), Sore throat (new or worsening), New loss of taste, New loss of smell
Has anyone in your household tested positive for COVID-19 through a diagnostic test in the past 14 days?
Have you, your child or anyone in your household spent more than 24 hours in the last 14 days in a state with significant community spread of the coronavirus? The states currently are Alabama, Arizona, Arkansas, California, Delaware, Florida, Georgia, Iowa, Idaho, Kansas, Louisiana, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Utah.
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. Name of person completing this form
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