Sign In Little Hands Home Daycare
Daily health screen and sign in
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Person completing form *
Child’s Name *
Required
Does any child in the household have a temperature of 100.4° or higher? *
If yes, child may not be admitted to care
Does any child in the household have symptoms (such as cough, shortness of breath, difficulty breathing, new loss of taste or smell, fever of 100.4° or higher, chills or shaking chills, muscle aches, headache, sore throat, nausea or vomiting, diarrhea, fatigue, congestion or runny nose) *
If the answer to any symptoms is yes, the child may not be admitted to care
Has anyone in the household, In the last 14 days, had contact (within 6 feet for at least 15 minutes) with anyone diagnosed with COVID-19 or suspected to have COVID-19 *
If yes, child may not be admitted to care
Is anyone in your household waiting for a COVID-19 test result, diagnosed with COVID-19, or instructed by any health care provider or the health department to isolate or quarantine *
If yes, child may not be admitted to care
Make sure to show temperature to daycare provider *
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