DAILY COVID-19 QUESTIONNAIRE PIXIE WONDERLAND DAILY QUESTIONS FOR CHILDRENDAILY QUESTIONS FOR ADULTS Daily questions for CHILDREN:What is your name?How old are you?How are you feeling today?Are you feeling well?*YesNoDo you feel hot?*YesNoDo you have a cough?*YesNoIs it easy for you to breathe?*YesNoDo you have a sore throat?*YesNo Daily questions for ADULTS:Name* First Last Reason for entering the premises:*ParentCarerStaffVisitorWithin the last 14 days have you been in contact with someone confirmed to have Covid-19?*YesNoDo you currently have any of the following symptoms?fever*YesNocough*YesNosore throat*YesNoredness of eyes*YesNoshortness of breath*YesNodifficulty breathing*YesNoPLEASE NOTE: if you answered yes to any of these questions, please REMAIN at home. Please indicate your current temperature:Confirmation* I declare the above information to be true and correct.
