NICU Visitor Health Screening Form

Directions: Follow Banner Gating Criteria for current visitation guidelines. We support family centered care and understand that visitors may be important in the healing process. We also know the importance of keeping your baby, your family, and the staff safe. Therefore, all visitors will be screened for illness each time upon entering the neonatal intensive care unit. All visitors should perform hand hygiene upon entering and exiting the unit and patient room.