COVID-19: Screening Checklist for Visitors and Employees

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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