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  • ILLNESS LOG SYMPTOMS ACTION TAKEN · OOL/1.6.2018 . Centers must report to the OOL by the next working day and submit documentation within one week when an illness results in a call
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ILLNESS LOG For the documentation of illnesses, symptoms of illness, or diseases that are exhibited by each child while in the center’s care and the exclusion of children as a result of the COVID-19 daily health screening. This log may be used to document COVID-19 related staff exclusions. NAME CHILD STAFF DATE TIME DATE REMOVED DATE RETURNED SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY) Cough Diarrhea Difficulty Breathing Eye Redness/Discharge Other: Fever Nausea/Vomiting Pain/Discomfort Rash/Ringworm COVID-19 Symptoms 2 Rested at Center Child Picked Up Denied Entry 2 Called 911 1 Other: Emergency Medical Care Provided 1 Health Department Notified Health Care Provider Note Symptom-Free Isolation/Quarantine Complete COVID-19 Negative Result Other: NAME CHILD STAFF DATE TIME DATE REMOVED DATE RETURNED SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY) Cough Diarrhea Difficulty Breathing Eye Redness/Discharge Other: Fever Nausea/Vomiting Pain/Discomfort Rash/Ringworm COVID-19 Symptoms 2 Rested at Center Child Picked Up Denied Entry 2 Called 911 1 Other: Emergency Medical Care Provided 1 Health Department Notified Health Care Provider Note Symptom-Free Isolation/Quarantine Complete COVID-19 Negative Result Other: NAME CHILD STAFF DATE TIME DATE REMOVED DATE RETURNED SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY) Cough Diarrhea Difficulty Breathing Eye Redness/Discharge Other: Fever Nausea/Vomiting Pain/Discomfort Rash/Ringworm COVID-19 Symptoms 2 Rested at Center Child Picked Up Denied Entry 2 Called 911 1 Other: Emergency Medical Care Provided 1 Health Department Notified Health Care Provider Note Symptom-Free Isolation/Quarantine Complete COVID-19 Negative Result Other: NAME CHILD STAFF DATE TIME DATE REMOVED DATE RETURNED SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY) Cough Diarrhea Difficulty Breathing Eye Redness/Discharge Other: Fever Nausea/Vomiting Pain/Discomfort Rash/Ringworm COVID-19 Symptoms 2 Rested at Center Child Picked Up Denied Entry 2 Called 911 1 Other: Emergency Medical Care Provided 1 Health Department Notified Health Care Provider Note Symptom-Free Isolation/Quarantine Complete COVID-19 Negative Result Other: NAME CHILD STAFF DATE TIME DATE REMOVED DATE RETURNED SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY) Cough Diarrhea Difficulty Breathing Eye Redness/Discharge Other: Fever Nausea/Vomiting Pain/Discomfort Rash/Ringworm COVID-19 Symptoms 2 Rested at Center Child Picked Up Denied Entry 2 Called 911 1 Other: Emergency Medical Care Provided 1 Health Department Notified Health Care Provider Note Symptom-Free Isolation/Quarantine Complete COVID-19 Negative Result Other: NAME CHILD STAFF DATE TIME DATE REMOVED DATE RETURNED SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY) Cough Diarrhea Difficulty Breathing Eye Redness/Discharge Other: Fever Nausea/Vomiting Pain/Discomfort Rash/Ringworm COVID-19 Symptoms 2 Rested at Center Child Picked Up Denied Entry 2 Called 911 1 Other: Emergency Medical Care Provided 1 Health Department Notified Health Care Provider Note Symptom-Free Isolation/Quarantine Complete COVID-19 Negative Result Other: 1 Centers must report to the OOL by the next working day and submit documentation through NJCCIS within one week when an illness results in a call to 911, a child visiting the emergency room or being admitted to the hospital, or a child receiving on-site or transported emergency care/urgent care. Refer to Reporting Requirements for Communicable Diseases and Work-Related Conditions Quick Reference guide at http://www.nj.gov/health/cd/documents/reportable_disease_magnet.pdf. 2 Staff and/or children exhibiting COVID-19 symptoms must be denied entry/immediately excluded. Positive cases of COVID-19 must be immediately reported to the local health department and the OOL. OOL/05.26.2021

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  • I LLN E SS LOG For the documentation of illnesses, symptoms of illness, or diseases that are exhibited by each child while in the center’s care and the exclusion of children as a result of the COVID-19 daily health screening. This log may be used to document COVID-19 related staff exclusions.

    NAME CHILD STAFF

    DATE TIME DATE REMOVED DATE RETURNED

    SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY)

    Cough

    Diarrhea

    Difficulty Breathing

    Eye Redness/Discharge

    Other:

    Fever

    Nausea/Vomiting

    Pain/Discomfort

    Rash/Ringworm

    COVID-19

    Symptoms2

    Rested at Center

    Child Picked Up

    Denied Entry2

    Called 9111

    Other:

    Emergency Medical

    Care Provided1

    Health Department

    Notified

    Health Care Provider Note

    Symptom-Free

    Isolation/Quarantine Complete

    COVID-19 Negative Result

    Other:

    NAME CHILD STAFF

    DATE TIME DATE REMOVED DATE RETURNED

    SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY)

    Cough

    Diarrhea

    Difficulty Breathing

    Eye Redness/Discharge

    Other:

    Fever

    Nausea/Vomiting

    Pain/Discomfort

    Rash/Ringworm

    COVID-19

    Symptoms2

    Rested at Center

    Child Picked Up

    Denied Entry2

    Called 9111

    Other:

    Emergency Medical

    Care Provided1

    Health Department

    Notified

    Health Care Provider Note

    Symptom-Free

    Isolation/Quarantine Complete

    COVID-19 Negative Result

    Other:

    NAME CHILD STAFF

    DATE TIME DATE REMOVED DATE RETURNED

    SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY)

    Cough

    Diarrhea

    Difficulty Breathing

    Eye Redness/Discharge

    Other:

    Fever

    Nausea/Vomiting

    Pain/Discomfort

    Rash/Ringworm

    COVID-19

    Symptoms2

    Rested at Center

    Child Picked Up

    Denied Entry2

    Called 9111

    Other:

    Emergency Medical

    Care Provided1

    Health Department

    Notified

    Health Care Provider Note

    Symptom-Free

    Isolation/Quarantine Complete

    COVID-19 Negative Result

    Other:

    NAME CHILD STAFF

    DATE TIME DATE REMOVED DATE RETURNED

    SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY)

    Cough

    Diarrhea

    Difficulty Breathing

    Eye Redness/Discharge

    Other:

    Fever

    Nausea/Vomiting

    Pain/Discomfort

    Rash/Ringworm

    COVID-19

    Symptoms2

    Rested at Center

    Child Picked Up

    Denied Entry2

    Called 9111

    Other:

    Emergency Medical

    Care Provided1

    Health Department

    Notified

    Health Care Provider Note

    Symptom-Free

    Isolation/Quarantine Complete

    COVID-19 Negative Result

    Other:

    NAME CHILD STAFF

    DATE TIME DATE REMOVED DATE RETURNED

    SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY)

    Cough

    Diarrhea

    Difficulty Breathing

    Eye Redness/Discharge

    Other:

    Fever

    Nausea/Vomiting

    Pain/Discomfort

    Rash/Ringworm

    COVID-19

    Symptoms2

    Rested at Center

    Child Picked Up

    Denied Entry2

    Called 9111

    Other:

    Emergency Medical

    Care Provided1

    Health Department

    Notified

    Health Care Provider Note

    Symptom-Free

    Isolation/Quarantine Complete

    COVID-19 Negative Result

    Other:

    NAME CHILD STAFF

    DATE TIME DATE REMOVED DATE RETURNED

    SYMPTOMS (CHECK ALL THAT APPLY) RESPONSE ACTIONS (CHECK ALL THAT APPLY) READMITTED BASED ON (CHECK ALL THAT APPLY)

    Cough

    Diarrhea

    Difficulty Breathing

    Eye Redness/Discharge

    Other:

    Fever

    Nausea/Vomiting

    Pain/Discomfort

    Rash/Ringworm

    COVID-19

    Symptoms2

    Rested at Center

    Child Picked Up

    Denied Entry2

    Called 9111

    Other:

    Emergency Medical

    Care Provided1

    Health Department

    Notified

    Health Care Provider Note

    Symptom-Free

    Isolation/Quarantine Complete

    COVID-19 Negative Result

    Other:

    1Centers must report to the OOL by the next working day and submit documentation through NJCCIS within one week when an illness results in a call to 911, a child visiting the emergency room or being admitted to the hospital, or a child receiving on-site or transported emergency care/urgent care. Refer to

    Reporting Requirements for Communicable Diseases and Work-Related Conditions Quick Reference guide at http://www.nj.gov/health/cd/documents/reportable_disease_magnet.pdf.

    2Staff and/or children exhibiting COVID-19 symptoms must be denied entry/immediately excluded. Positive cases of COVID-19 must be immediately reported to the local health department and the OOL.

    OOL/05.26.2021

    NAME: undefined: Offundefined_2: OffDATE: TIME: DATEREMOVED: DATERETURNED: Cough: OffDiarrhea: OffDifficultyBreathing: OffEyeRednessDischarge: OffOther: OffFever: OffNauseaVomiting: OffPainDiscomfort: OffRashRingworm: OffCOVID19: OffRestedatCenter: OffChildPickedUp: OffDeniedEntry2: OffCalled9111: OffOther_2: OffEmergencyMedical: OffHealthDepartment: OffHealthCareProviderNote: OffSymptomFree: OffIsolationQuarantineComplete: OffCOVID19NegativeResult: OffOther_3: OffNAME_2: undefined_3: Offundefined_4: OffDATE_2: TIME_2: DATEREMOVED_2: DATERETURNED_2: Cough_2: OffDiarrhea_2: OffDifficultyBreathing_2: OffEyeRednessDischarge_2: OffOther_4: OffFever_2: OffNauseaVomiting_2: OffPainDiscomfort_2: OffRashRingworm_2: OffCOVID19_2: OffRestedatCenter_2: OffChildPickedUp_2: OffDeniedEntry2_2: OffCalled9111_2: OffOther_5: OffEmergencyMedical_2: OffHealthDepartment_2: OffHealthCareProviderNote_2: OffSymptomFree_2: OffIsolationQuarantineComplete_2: OffCOVID19NegativeResult_2: OffOther_6: OffNAME_3: undefined_5: Offundefined_6: OffDATE_3: TIME_3: DATEREMOVED_3: DATERETURNED_3: Cough_3: OffDiarrhea_3: OffDifficultyBreathing_3: OffEyeRednessDischarge_3: OffOther_7: OffFever_3: OffNauseaVomiting_3: OffPainDiscomfort_3: OffRashRingworm_3: OffCOVID19_3: OffRestedatCenter_3: OffChildPickedUp_3: OffDeniedEntry2_3: OffCalled9111_3: OffOther_8: OffEmergencyMedical_3: OffHealthDepartment_3: OffHealthCareProviderNote_3: OffSymptomFree_3: OffIsolationQuarantineComplete_3: OffCOVID19NegativeResult_3: OffOther_9: OffNAME_4: undefined_7: Offundefined_8: OffDATE_4: TIME_4: DATEREMOVED_4: DATERETURNED_4: Cough_4: OffDiarrhea_4: OffDifficultyBreathing_4: OffEyeRednessDischarge_4: OffOther_10: OffFever_4: OffNauseaVomiting_4: OffPainDiscomfort_4: OffRashRingworm_4: OffCOVID19_4: OffRestedatCenter_4: OffChildPickedUp_4: OffDeniedEntry2_4: OffCalled9111_4: OffOther_11: OffEmergencyMedical_4: OffHealthDepartment_4: OffHealthCareProviderNote_4: OffSymptomFree_4: OffIsolationQuarantineComplete_4: OffCOVID19NegativeResult_4: OffOther_12: OffNAME_5: undefined_9: Offundefined_10: OffDATE_5: TIME_5: DATEREMOVED_5: DATERETURNED_5: Cough_5: OffDiarrhea_5: OffDifficultyBreathing_5: OffEyeRednessDischarge_5: OffOther_13: OffFever_5: OffNauseaVomiting_5: OffPainDiscomfort_5: OffRashRingworm_5: OffCOVID19_5: OffRestedatCenter_5: OffChildPickedUp_5: OffDeniedEntry2_5: OffCalled9111_5: OffOther_14: OffEmergencyMedical_5: OffHealthDepartment_5: OffHealthCareProviderNote_5: OffSymptomFree_5: OffIsolationQuarantineComplete_5: OffCOVID19NegativeResult_5: OffOther_15: OffNAME_6: undefined_11: Offundefined_12: OffDATE_6: TIME_6: DATEREMOVED_6: DATERETURNED_6: Cough_6: OffDiarrhea_6: OffDifficultyBreathing_6: OffEyeRednessDischarge_6: OffOther_16: OffFever_6: OffNauseaVomiting_6: OffPainDiscomfort_6: OffRashRingworm_6: OffCOVID19_6: OffRestedatCenter_6: OffChildPickedUp_6: OffDeniedEntry2_6: OffCalled9111_6: OffOther_17: OffEmergencyMedical_6: OffHealthDepartment_6: OffHealthCareProviderNote_6: OffSymptomFree_6: OffIsolationQuarantineComplete_6: OffCOVID19NegativeResult_6: OffOther_18: OffOther1: 0: 1: 2: 3: 4: 5:

    Other2: 0: 1: 2: 3: 4: 5:

    Text3: 0: 1: 2: 3: 4: 5:


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