OCFS-6040 (6/2020) NEW YOK STATE OFFICE OF CHILDREN AND FAMILY SERVICES CHILD CARE EMPLOYEE, VOLUNTEER, PARENT, CHILD AND ESSENTIAL VISITORS HEALTH SCREENING ONE-TIME ATTESTATION

NYS OCFS Child Care Employee, Volunteer, Parent, Child And Essential Visitors Health Screening One-time Attestation

Before entering a child care program, employees, volunteers, parents, children and essential visitors must complete a health screening questionnaire daily. In addition, each employee, volunteer, parent, child and essential visitor must sign and submit this form to the program one time. Employees, volunteers, parents, children and essential visitors must answer all questions and take their temperature daily to confirm a body temperature lower than 100.0 degrees Fahrenheit. If anyone answers “Yes” to any of the questions below, they cannot enter the child care program. A parent or guardian is responsible for completing daily screening on behalf of their child(ren).