Fillable Daily Log of Entry Health Screenings and Attendance (State of New Jersey)

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Daily Log of Entry Health Screenings and Attendance (State of New Jersey)

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OOL/10.01.2020
Daily Log of Entry Health Screenings and Attendance
Logs for
each day of the week shall be submitted to the OOL every Friday.
Complete the checklist below for each visitor, staff member, and child prior to entering or being admitted to the center each day.
Childcare programs operating in public school buildings and receiving children directly from school shall not be required to screen
children a second time upon arrival. Children who meet the following criteria should be promptly isolated and excluded from the facility for
10 days from symptom onset, or until they receive an alternate diagnosis from a healthcare provider or a negative COVID-19 test result.
Date:
License ID:
City:
Center Name:
Name
Visitor
Staff
Age 0-2.5
Age 2.5-5
Age 6-13
Temperature
Symptoms
Contact
Travel
Temp.
Upon
Arrival
Is Temperature
100.4 F or
Higher?
At least 2 of the following:
Chills, Shivers, Muscle
Aches, Headache,
Sore Throat,
Nausea/Vomiting,
Diarrhea, Fatigue,
Congestion/Runny Nose
At least 1 of the
following: Cough,
Shortness of
Breath, Difficulty
Breathing, New
Loss of Taste or
Smell
Close contact
(within 6 feet for at
least 10 minutes)
with a person with
confirmed COVID-
19 in the Past 14
Days?
Someone in the
household that
has symptoms
of COVID-19 or
is diagnosed
with COVID-19?
Travel to an
Area of High
Community
Transmission*?
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
Attendance Totals
Total Exclusions
*NJ Travel Advisory List: https://covid19.nj.gov/faqs/nj-information/travel-and-transportation/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey
**Exclusion criteria based on New Jersey Department of Health COVID-19 Public Health Recommendations.
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Daily Log of Entry Health Screenings and Attendance (State of New Jersey)

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Completed 26 October 2020

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