Daily Health Checks

• Conducted on

  Date

• Prepared by

Child #1

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #2

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #3

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #4

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #5

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #6

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #7

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

Child #8

• Child's Name:

• Please select all that apply:

  Select Absent Bruise Bug Bite Cough Diarrhea Fever Nasal Discharge Rash Red Mark Scratch/Cut Over Tired Vomiting

  • Absent
  • Bruise
  • Bug Bite
  • Cough
  • Diarrhea
  • Fever
  • Nasal Discharge
  • Rash
  • Red Mark
  • Scratch/Cut
  • Over Tired
  • Vomiting

• Please indicate location of injury/markings:

• Please do not submit your Inspection until you've completed Health Checks on all of your children.

• Additional Comments:

• Staff Signature

  Sign