Childcare Center Cook Health Monitoring Form
Date
Cook's Name
Shift
Morning
Afternoon
Evening
Health Assessment
Body Temperature (°C)
Cough, Sore Throat, Shortness of Breath
No
Yes
Vomiting/Diarrhea/Nausea
No
Yes
Skin Lesions (Cuts/Boils/Rash)
No
Yes
Other Symptoms
Supervisor Review
Action Taken / Remarks
Supervisor Signature
Review Date