Twin Parks Montessori Reopening Guidelines | Covid-19

New York State Office of Children and Family Services

CHILD CARE EMPLOYEE, CHILD, AND ESSENTIAL VISITORS HEALTH SCREENING ATTESTATION

Before entering a child care program, employees, parents (on behalf of children), and essential visitors must complete a daily health screening questionnaire. In addition, each employee, child’s parent, and essential visitor must sign and submit this form to the program. Employees, child(ren)’s parents, and essential visitors must answer all questions and take their temperature(s) daily to confirm a body temperature lower than 100.0°F. If anyone answers “Yes” to any of the questions below, they cannot enter the child care program. A parent or guardian is responsible for completing the daily screening on behalf of their child(ren). Self-Screening: Below are the self-screening questions that employees, parents of child(ren), and essential visitors are required to answer daily. If any of the answers to the below questions are “Yes,” individuals cannot enter the program. If the answers are “No” to all the following questions, individuals may enter the program. If employees, children’s parents, and essential visitors cannot take their temperature at home, but answer “No” to all other questions, they may report to the program to have their temperature taken on site.
Campus Location*
- Central Park
- Park West
- Riverside
Has the individual (enrolled child/ren or staff member) had a temperature higher than or equal to 100.0°F in the last 24 hours?*
- Yes
- No
Has the individual (enrolled child/ren or staff member) had any known contact with a person confirmed or suspected to have COVID-19 in the past 14 days?*
- Yes
- No
Is the individual (enrolled child/ren or staff member) currently experiencing ANY of the following symptoms?*
- Cough (new or worsening)
- Shortness of breath (new or worsening)
- Trouble breathing (new or worsening)
- Fever
- Chills
- Muscle pain (new or worsening)
- Headache (new or worsening)
- Sore throat (new or worsening)
- New loss of taste
- New loss of smell
- Runny nose and congestion (new or worsening)
- I am not experiencing any of these symptoms
Check all that may apply.
Has the individual (enrolled child/ren or staff member) or any members of their household tested positive for COVID-19 through a diagnostic test in the past 14 days?**
- Yes
- No
If you have answered “NO” to all questions, you may enter the program. If you have answered “YES” to any question, you will not be permitted to enter the program.
Attestation*
I agree to the following statement
By signing this document, I agree that I will monitor these symptoms each day and report the outcome per the instructions above and will not enter or drop off my child(ren) at the child care program if any of the above symptoms or conditions are present.
Your Name*
First Last
Child's Name
First Last
Date of Submission*
Date Format: MM slash DD slash YYYY
Time of Submission

: HH

MM
Signature*

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New York State Office of Children and Family Services

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