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