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Daily COVID-19 Pre-Screening - BHS GIRLS BASKETBALL
NJ State Interscholastic Athletic Association
1161 Route 130 North, Robbinsville, NJ 08691-1104
Phone 609-259-2775 Fax 609-259-3047
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* Indicates required question
Name of Student
*
Your answer
Date
*
MM
/
DD
/
YYYY
Parent/Guardian Cell
*
Your answer
Sport
*
Your answer
Are you experiencing any of the following symptoms?
Fever (>100.4F)?
*
Yes
No
Cough or shortness of breath?
*
Yes
No
Sore Throat?
*
Yes
No
Chills?
*
Yes
No
Muscle aches or rigors?
*
Yes
No
Headache?
*
Yes
No
New loss of taste or smell?
*
Yes
No
Abdominal pain, nausea, vomiting or diarrhea?
*
Yes
No
Have you had close contact with someone who is currently sick?
*
Yes
No
Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
*
Yes
No
Have you travelled or had close contact with anyone who has travelled internationally in the last 14 days?
*
Yes
No
If you took your temperature this morning, what was the reading?
Your answer
Each student must complete this form daily before every practice/game. Screening questionnaires must be completed prior to arriving on school grounds.
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