Daily Covid-19 Screen Freeport Marching Band

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The following daily screening form is completed for monitoring the possibility of contracting and spreading the COVID-19 virus. We expect the guidance of a parent when filling out this daily form. We also will NOT accept this form as valid unless taken on the day of practice/game. If you answer YES to any of these questions, please discuss the possibility of seeking medical advice. On the question(s) you answer “yes,” please elaborate on any information you can add to the final question that helps us understand your situation.

Please answer the following questions to the best of your ability as it relates to your current health:

LAST Name *

FIRST Name *

Are you experiencing a fever at this time, or in the past 2 days? *

Yes

Are you experiencing a chills at this time, or in the past 2 days? *

Yes

Are you experiencing unusual fatigue at this time, or in the past 2 days? *

Yes

Are you experiencing an unusual cough at this time, or in the past 2 days? *

Yes

Are you experiencing unusual shortness of breath at this time, or in the past 2 days? *

Yes

Are you experiencing an unusually sore throat at this time, or in the past 2 days? *

Yes

Are you experiencing any unusual body aches/pains at this time, or in the past 2 days, not related to exercise? *

Yes

Are you experiencing any unusual loss of taste or smell at this time, or in the past 2 days? *

Yes

Are you experiencing a pain/difficulty in breathing at this time, or in the past 2 days? *

Yes

Are you experiencing any unusual changes in vision/eye discharge at this time, or in the past 2 days? *

Yes

Since the last time filling out the COVID-19 screening form, have you been exposed to anyone who has been diagnosed with COVID-19? *

Yes

Travel Restriction: Within the last 14 calendar days, have you traveled to a U.S. State considered a "hot spot" that is on the PA-travel restriction list? *

Yes

If you answered “yes” to any of the above questions, please provide us details of your situation as it pertains to potential COVID-19 or other. Please do not enter campus if you answered "yes" to any of the above questions. If you answered "no" all all questions, please write "N/A" *

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