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YPA Athletics COVID-19 Symptoms Screening
This form is for use of daily health screening of athletes, coaches, and staff. If an individual answers YES to any of these questions, they cannot participate on that day, and cannot stay on site.
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* Indicates required question
Name: First and Last
*
Your answer
What is your role?
*
Student Athlete
Coach/staff member
Required
Do you have a cough?
*
Yes
No
Required
Do you have any difficulty breathing?
*
Yes
No
Required
Do you have a NEW loss of sense of smell or taste?
*
Yes
No
Required
Do you have a sore throat?
*
Yes
No
Required
Have you had any recent diarrhea or vomiting?
*
Yes
No
Required
Have you had any contact with a person known to be infected with COVID-19 within the last 14 days?
*
Yes
No
Required
Do you have a compromised immune system or chronic disease?
*
Yes
No
Required
Have you had a fever of 100.4 or higher in the past 72 hours?
*
Yes
No
Required
Current Temperature: If temperature is greater than 100.4, send student/staff home
*
Your answer
If you answered YES to any of the above questions: please provide a description of why you answered yes.
Your answer
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