Warrior Season 4 AND SUMMER Check-in/COVID-19 Screening Form

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This form must be filled out by EVERY individual prior to entering facility.

NAME *

First AND Last Name Please

ID# *

What is your BSD Student ID Number? (Coaches/others enter email address please.)

Sport *

What team(s) are you participating with today? OSAA ALLOWS A TOTAL OF THREE HOURS OF PRACTICE PER DAY

Boys Basketball

Girls Basketball

Wrestling

Summer Baseball (workouts)

Summer Football (workouts)

Summer OTHER (practices/workouts)

Required

Water *

Did you bring adequate water for today's workout?

Yes

Signs/Symptoms *

In the last 48 hours, have you experienced any of the following signs/symptoms of COVID (not attributed to workout)? (Fever/chills, new or worsening cough, trouble/difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion, runny nose, nausea/vomiting, diarrhea, persistent pain or pressure in the chest.)

Yes

COVID-19 Testing/Diagnosis *

Have you been tested for or diagnosed with COVID-19 within the past 14 days?

Yes

Self Quarantine *

Did the county health department or a medical professional instruct you to self-quarantine, in the past 14 days?

Yes

Close Contact *

In the past 14 days, has anyone in your household or living space had a COVID-19 diagnosis or awaiting a test result? Have you had close contact with or cared for someone with COVID-19 in the past 14 days? (coughed/sneezed on, sharing utensils/drink containers, or being in close proximity for a longer period of time or frequent shorter contacts with an individual with a suspected or confirmed COVID-19.)

Yes

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