COVID-19 DAILY SCREENING FORM

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Fill out this form EVERYDAY before reporting to SS&CC!
Must be filled out ON THE DAY you are participating.
If your temp is over 99.9, you have any of the symptoms on the list, or been in close contact with a person who is lab confirmed to have COVID-19, STAY HOME!

Student Athlete FULL NAME *

Student Athlete Grade for 2020-21 *

Senior

Junior

Sophomore

Freshman

8th Grade

7th Grade

Coach

Daily Teperature Check (Take your temperature before coming to SS&CC and record it here. If your temp is over 99.9, STAY HOME!) *

Daily Sympton Check (Check the box for any symptoms you have today. If you check any boxes, STAY HOME) *

Cough

Shortness of breath/ Difficulty breathing

Chills

Repeated shaking with chills

Muscle pain (other than normal soreness from your workout)

Headache

Sore throat

Loss of taste or smell

Diarrhea

NO SYMPTOMS TODAY

Required

Have you been in close contact with a person who is lab confirmed to have COVID-19? (If yes, STAY HOME!) *

Yes

I, the aboved named student athlete, certify that all of the above information is true to the best of my knowledge. *

I CERTIFY

I DO NOT certify

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