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Fremont Covid-19 Health Screen Test
Please answer all questions honestly. Please show the confirmation message to the coach/check in person BEFORE you take your temperature.
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* Indicates required question
Email
*
Your email
Player Name (FIRST & LAST)
*
Your answer
What team/program are you here for?
*
Choose
City Beach Camp/Clinic
Ohlone Jrs
Vision
Nor Cal
In the last 24 hours, have you experienced shortness of breath or having trouble breathing ?
*
YES
NO
In the last 24 hours, have you experienced an unexplained cough or sore throat unrelated to asthma or allergies?
*
YES
NO
In the last 24 hours, have you experienced chills or had a fever?
*
YES
NO
In the last 24 hours, have you experienced a new loss of taste or smell?
*
YES
NO
In the last 24 hours, have you experienced any fatigue, muscle, or body aches?
*
YES
NO
In the last 24 hours, have you experienced any headaches, congestion, or a runny nose?
*
YES
NO
In the last 24 hours, have you experienced any nausea, vomiting, or diarrhea?
*
YES
NO
I have been in close contact or cared for someone who is exhibiting COVID-19 symptoms.
*
YES
NO
A copy of your responses will be emailed to the address you provided.
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