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Daily Fall Pre-Practice COVID-19 Symptom Form
Please complete this form each day of practice prior to 1:00 PM. Please complete the night before for our Saturday rehearsals and football games.
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Email
*
Your email
First Name of Student
Your answer
Last Name of Student
Your answer
Date
MM
/
DD
/
YYYY
Are you experiencing any of the following syptoms (Fever (> or = to 100.4 F, cough or shortness of breath, sore throat, chills, muscle aches or rigors, headache, new loss of taste or smell, abdominal pain, nausea, vomiting or diarrhea)?
Yes
No Symptoms
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If "Yes", please list the symptoms experienced. If "No symptoms", please write "No".
Your answer
Have you had close contact with someone is currently sick?
Yes
No
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Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
Yes
No
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Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?
Yes
No
Clear selection
Send me a copy of my responses.
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