COVID-19: Screening Checklist for Visitors and Employees
Healthcare providers and assisted living providers can use this COVID-19 screening checklist to help ensure the safety of their institutions and control the spread of the SARS-CoV-2 virus. Please note that this screening checklist provides basic information only. It is not intended to take the place of medical advice, diagnosis or treatment.
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Screening
This checklist is derived from https://www.ahcancal.org/facility_operations/disaster_planning/Documents/COVID19-Screening-Checklist-SNF-Visitors.pdf
On March 13, 2020, CMS and CDC updated guidance on restricting all SNF visitors and non-essential healthcare personnel, except for certain compassionate care situations, such as end-of-life
ALL individuals (employees, family, visitors, government officials) entering the building must be asked the following questions:
Has this individual washed their hands or used alcohol-based hand rub (ABHR) on entry?
Please ask them to do so
Ask the individual if they have any of the following respiratory symptoms? (If YES to any, restrict them from entering the building)
Fever
Sore throat
Cough
New shortness of breath
Restrict them from entering the building
If NO to all, is the individual an employee of this institution?
3A. For employees, check temperature and document results (not required for visitors)
Fever present?
Restrict from entering the building
3B. For employees, ask if they have:
Worked in facilities with recognized COVID-19 cases?
If YES, ask if they worked with person with confirmed COVID-19?
If YES, restrict them from entering the building
4. Allow entry to building and remind the individual to:
Wash their hands or use ABHR throughout their time in the building.
Not shake hands with, touch or hug individuals during their visit.
Visitors that are permitted for compassionate care situations must wear a facemask while in the building and restrict their visit to the resident’s room or other location designated by the facility.
4. Allow entry to building and remind the individual to:
Wash their hands or use ABHR throughout their time in the building.
Not shake hands with, touch or hug individuals during their visit.
Visitors that are permitted for compassionate care situations must wear a facemask while in the building and restrict their visit to the resident’s room or other location designated by the facility.
4. Allow entry to building and remind the individual to:
Wash their hands or use ABHR throughout their time in the building.
Not shake hands with, touch or hug individuals during their visit.
Visitors that are permitted for compassionate care situations must wear a facemask while in the building and restrict their visit to the resident’s room or other location designated by the facility.
Note: Assisted Living Providers can use this checklist as feasible for their community
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Comments
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SafetyCulture Staff
COVID-19: Screening Checklist for Visitors and Employees
Healthcare providers and assisted living providers can use this COVID-19 screening checklist to help ensure the safety of their institutions and control the spread of the SARS-CoV-2 virus. Please note that this screening checklist provides basic information only. It is not intended to take the place of medical advice, diagnosis or treatment.
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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended
to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or
treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such
checklist is
permissible in your workplace or jurisdiction.
