HWJH CHEER/Pom Covid-19 Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

YOU MUST COMPLETE THIS DAILY

First and Last Name; *

Today’s Date *

YYYY

Time *

Time

School Site *

Sport *

What was your temp at check-in? *

1 point

Which coach took your temp? *

1 point

If you have been tested for Covid-19 & your test results were negative; or if you’ve not had a reason to be tested, answer yes. *

1 point

Yes

Do you understand that even with a negative test result, you might still be exposed to someone who is COVID-19 positive, and may need to be retested? *

1 point

Yes

Have you experienced any of the following symptoms in the previous 2 weeks: fever, chills, difficulty breathing, dry cough, stomach troubles, muscle pain, headache, sore throat, loss of taste or smell? *

1 point

Yes

To the best of your knowledge, has anyone you live with experienced any of the following symptoms in the previous 2 weeks: fever, chills, difficulty breathing, dry cough, stomach troubles, muscle pain, headache, sore throat, loss of taste or smell? *

1 point

Yes

If you’re attending practices at a private gym/facility, is that gym/facility requiring patrons to complete a COVID-19 survey & are they requiring the same measures SHS is (masks, hand washing/sanitizing, social distancing, temp checks)? *

1 point

Yes

Did you remember to eat breakfast; and did you bring a mask/face covering, a gallon of drinking water, a bottle of hand sanitizer, a towel, & all of your necessary equipment/gear today? *

1 point

Yes

Do you understand that you must wear a mask at all times while inside a building or in close proximity to other people? *

1 point

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms