illness log symptoms action taken · ool/1.6.2018 . centers must report to the ool by the next...
TRANSCRIPT
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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: