At Home Daily Health Screening (all)

At Home Daily Health Screening

Rainbow Child Development Center
Before entering Rainbow CDC, employees, children, and parents/guardians must complete a daily health screening and have his/her temperature measured at the entrance. Your temperature must be less than or equal to 99.9 degrees Fahrenheit in order to enter Rainbow CDC.

Below are the self-screening questions that you are required to answer daily.
Center Location *
I am entering Rainbow CDC as a: *

child parent/guardian employee
Child's Name: *

First Name Last Name
Parent/Guardian's Name: *

First Name Last Name
Employee's Name: *

First Name Last Name
1. Is your temperature higher than or equal to 100.0 degrees Fahrenheit? *

No Yes
2. Have you had any known contact with a person confirmed or suspected to have COVID-19 in the past 14 days? *

No Yes
3. Are you currently experiencing ANY of the following symptoms: *

Cough (new or worsening) Shortness of breath Trouble breathing Fever Chills Muscle pain (new or worsening) Headache (new or worsening) Sore throat (new or worsening) New loss of taste New loss of smell None
4. Have you tested positive for COVID-19 in the past 14 days? *

No Yes
If you answered "No" to all questions, you may enter Rainbow CDC.

If you answered "Yes" to any question, you will not be allowed to enter Rainbow CDC.

ATTESTATION: By signing this document, I agree that I (or my child and I, if I am the parent/guardian of a child attending Rainbow CDC) will self-monitor these symptoms each day and report the outcome per the instructions above and will not enter Rainbow CDC if any of the above symptoms or conditions are present.
Signature of Parent/Guardian *

Clear
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