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Patient name: Date of birth: (mo.) (yr.) (day) Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination For use with people age 3 through 49 years: The following
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Day screening checklist is used to ensure that all necessary safety measures and procedures are followed during the course of a day.
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All employees and contractors who are working on the premises are required to fill out and file the day screening checklist.
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Employees and contractors must fill out the checklist by documenting their tasks, any safety hazards encountered, and any safety precautions taken during the day.
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The purpose of the day screening checklist is to ensure a safe working environment and to prevent accidents or incidents.
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Information such as tasks performed, safety hazards encountered, safety precautions taken, and any incidents or near misses must be reported on the day screening checklist.
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