Nursing Home Visitor Screening Log

All visitors must complete this screening log upon entry to ensure the safety and health of our residents and staff. Please fill out each column accurately before proceeding to the visiting areas.

Date:                               

Visitor's Name	Time In	Time Out	Contact Number	Purpose of Visit	Health Screening Passed (Y/N)

Note: Visitors who do not pass the health screening should be kindly asked to reschedule their visit for a later date when they meet all health criteria.

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