Daily Health Screening

Employees, volunteers, parents, children and essential visitors are required to fill out this health screening form daily.


Individuals experiencing any of the symptoms listed below are not eligible to enter the program.


If you cannot take your temperature at home, and are not experiencing any of the other symptoms listed below, you may report to the program to have your temperature taken on site.

If you have answered “NO” to all questions, you may enter the program.

If you have answered “YES” to any question, you will not be allowed to enter the program.


Attestation: By submitting this questionnaire, I agree that I will self-monitor these symptoms each day, 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.