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SGT Health Screening
Please fill out this form before any SGT class. Your instructor cannot admit you to class without having your submitted answers.
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* Indicates required question
Name:
*
Your answer
Today's Date:
*
MM
/
DD
/
YYYY
TEMPERATURE
Please answer the following questions below.
Temperature
*
Your answer
Are you taking a fever reducing medication such as Advil or Tylenol?
*
Yes
No
CONTACT WITH OTHERS
Have you or anyone in your household tested positive for COVID-19?
*
Yes
No
Have you been in contact with anyone who has tested positive for COVID-19?
*
Yes
No
Symptom Tracker
Have you felt any of the following symptoms in the last 24 hours? [check all that apply]
*
Fever of 100 F or above, or possible fever symptoms like alternating chills and sweating
Trouble breathing, shortness of breath or severe wheezing
Headache
Muscle Aches
Cough
New loss of smell/taste
Nausea, diarrhea or vomiting
Sore Throat
Chills or repeated shaking with chills
NONE
Required
I agree that no symptom boxes have been checked off
*
Yes, I agree- I am symptom free.
No, I do not agree, I have checked off symptoms.
Required
By submitting this form, I agree the above information is true.
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