21.22 GMYS Symptom Checker

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This symptom checker is to be filled out before every GMYS rehearsal, concert or event. Students/volunteers will be allowed only after completing and receiving approval from GMYS staff. / Este verificador de síntomas se debe completar antes de cada ensayo, concierto o evento de GMYS. Los estudiantes / voluntarios serán permitidos solo después de completar y recibir la aprobación del personal de GMYS.

Please read each question carefully and answer truthfully/ Lea atentamente cada pregunta y responda con sinceridad .

Today’s date: *

YYYY

Parent Name

Student Name *

Phone number *

Have you experienced any of the following COVID-19 symptoms in the past 48 hours: • fever or chills • cough • shortness of breath or difficulty breathing • fatigue • muscle or body aches • headache • new loss of taste or smell • sore throat • congestion or runny nose • nausea or vomiting • diarrhea *

Yes

Within the past 14 days, have you been in close physical contact (6 feet or closer for at least 15 minutes) with a person who you know is confirmed to have COVID-19 or with anyone who has any of the symptoms you just responded to?

Yes

Clear selection

Are you supposed to be isolating or quarantining because you may have been exposed to COVID-19 or are you worried that you may be sick with COVID-19?

Yes

Clear selection

Are you currently waiting on the results of a COVID-19 test?

Yes

Clear selection

Submit

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