RHS Athletics Daily Symptom Monitoring Form
Daily monitoring of one's health and well-being prior to coming to work or school can aid in early detection of infectious diseases and is an effective measure to prevent community spread of COVID-19. In our ongoing effort to protect on-site participants, we have established a new practice: all student-athletes should complete this Daily Symptom Monitoring Form before participation in athletics.

Roosevelt High School continues to emphasize that all students who are feeling ill for any reason, should stay home for their well-being and the well-being of their peers. IF YOU ARE FEELING ILL, EXPERIENCING ANY COVID-19-LIKE SYMPTOMS, STAY HOME AND SCHEDULE AN APPOINTMENT WITH YOUR PRIMARY CARE PHYSICIAN OR OTHER HEALTH CARE PROVIDER.

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Student Last Name *
Student First Name *
Team *
Will be attending practice *
Indicate if you are currently experiencing or have experienced any of the following signs/symptoms since the last check-in: *
Yes
No
Cough
Sore throat
Shortness of breath or difficulty breathing
Chills
New loss of taste or smell
Diarrhea
Nausea/Vomiting (stomach ache)
Fatigue (tiredness/weakness)
Muscle or body aches
Congestion or runny nose
Headache
Close contact or care for someone currently being treated or quarantined for COVID-19 or pending testing results
I acknowledge that the information provided in this form is accurate. *
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