Use this COVID-19 screening form for the entry screening process for prevention of COVID-19 transmission.

All Ohio intermediate care facilities (ICFs) are required to use a screening tool for prevention of COVID-19 transmission in order to screen staff in facilities where they serve people with developmental disabilities. (Tool is attached to this page.)

Additionally, DODD encourages all providers of waiver-funded services to use a similar screening process. The Entry Screening Process for Prevention of COVID-19 Transmission is the recommended tool for ICF or waiver providers performing screening at their facilities (attached to this page).

The safety of Ohioans with developmental disabilities and the staff who care for them are a top priority. Thank you for what you are doing to support one another during this time.