Illness Checklist online form

Date

Centre name

Contact person

Phone number

Address 0/200 Words

Number of teachers

Number of children on the roll (each room)

What is the illness? (Have you visited our website to download the illness fact sheet? You may find all the information you need there: www.healthyecc.org.nz)

What are the symptoms? 0/250 Words

Is your illness register up to date?

Yes

No

When did the first child become ill?

How many children are away sick with the same symptoms?

How many staff are away sick with the same symptoms?

How many parents & siblings (not at centre) are sick with the same symptoms?

Has anyone been given a diagnosis from their family doctor?

Yes

No

Have any children been hospitalised?

Are any children on antibiotics or other medications?

Do you serve food/have shared food?

Yes

No

What have you done so far to control the outbreak? (i.e. Extra cleaning: bathrooms, surfaces, toys, linen, soft furnishings. Removed shared play - playdough, water play, art materials) 0/500 Words

Have you increased hand washing? (i.e. Before and after meal times. Teachers, children and parents on arrival to the centre)

What exclusion period are you applying? (Gastroenteritis illness - the exclusion period is 48hrs after last symptom)

What information have you given to parents? 0/500 Words

What else have you done to reduce the impact of the illness on your centre? 0/500 Words