Wellness Screening Tool for ALL Visitors
Wellness Screening Tool for ALL Visitors
For the safety and health of our residents, families, visitors and staff, we are asking that all visitors be screened for symptoms before entering any of our homes. If you answered yes to any of the questions listed or anyone you know has been in contact with anyone displaying signs and symptoms listed below or who has traveled to or been in contact with someone who has traveled to an affected area with COVID-19 (Please refrain from visiting)
SYMPTOM SCREENING
Do you (or anyone with you) have a
Fever?
NO
YES
Cough or shortness of breath?
NO
YES
Runny nose, eye drainage, sore throat, or other cold symptoms?
NO
YES
Skin rash?
NO
YES
Within the past 7 days, have you (or anyone with you) been exposed to the following?
Influenza, RSV, or other respiratory illness (fever, cough, sore throat)
NO
YES
Within the past 14 days, have you (or anyone with you) been exposed to the following?
COVID-19 (novel coronavirus)
NO
YES
Have you recently traveled to or been in contact with a person returning from an area with widespread or ongoing community spread of COVID-19?
NO
YES
Refer to the CDC Coronavirus webpage for COVID-19 areas: (www.cdc.gov/coronavirus/2019-ncov)
Within the past 3 weeks, have you (or your child, if present) been exposed to the following?
Pertussis/Chickenpox/Measles
NO
YES