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Football Summer 2020 at Home Screening
You must complete this form each morning before you arrive at Briarwood High School.
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First and Last Name
Your answer
Have you travelled outside of Alabama within the last 14 days? If yes, where?
Yes
No
Other:
Have you had contact* with a person with a confirmed or suspected case of COVID-19? *Contact is defined as less than 6 feet separation for more than 15 minutes without adequate personal protective equipment.
Yes, I have had contact with a person with a CONFIRMED case of COVID-19
Yes, I have had contact with a person with a SUSPECTED case of COVID-19
No
Clear selection
Have you had any of the following symptoms in the past 14 days? (check all that apply)
Fever
Forceful dry cough or productive cough
Difficulty breathing or shortness of breath
Chills or repeated shaking with chill
Unexplained muscle pain
A new or atypical headache
Nausea, vomiting, or diarrhea
Sore throat
A recent sudden loss of taste or smell
None of the above
Have you been tested for COVID-19 in the last 2 weeks? Yes, exception if done for preoperative screening, indicate below in other.
Yes
No
Other:
Submit
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