WesTech SOFTBALL COVID-19 Daily Screening Form

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This form is required to be completed by the student's parent/guardian each day that the student-athlete reports to a practice or game.

Email *

STUDENT FIRST NAME *

STUDENT LAST NAME *

STUDENT ID # *

On practice days only, a 5:30pm late bus will be available for student-athletes. Due to COVID-19 and our priority to keep our students safe and socially distanced, it is important we have an accurate count of who will need the bus on a given day. For those students who are requesting to ride the late bus, this form must be submitted by 10:00am. Will your child need the 5:30pm late bus today? *

Yes

Any of the symptoms below could indicate a COVID-19 infection in children and may put your child at risk for spreading illness to others. Please note that this list does not include all possible symptoms and children with COVID-19 may experience any, all or none of these symptoms. Please check your child daily for these symptoms.

SECTION A- IF TWO or MORE of the fields in this section are checked off, please keep your child home and notify the school for further instructions. *

Fever (measured or subjective)

Chills

Rigors (shivers)

Myalgia (muscle aches)

Headache

Sore Throat

Nausea or Vomiting

Diarrhea

Fatigue

Congestion or Runny Nose

NONE of the above.

Required

SECTION B- IF AT LEAST ONE field in this section is checked off, please keep your child home and notify the school for further instructions. *

Cough

Shortness of Breath

Difficulty Breathing

New Loss of Smell

New Loss of Taste

NONE of the above

Required

IF ANY of the fields in the Close Contact / Potential Exposure section are checked off, your child should remain home for 14 DAYS from the last date of exposure (if child a close contact of a confirmed COVID-19 case) or date of return to New Jersey.

Please verify if (Only check if applicable):

Your child has had close contact (within 6 feet of an infected person for 15 or more minutes during a 24-hour period) with a person with COVID-19.

Someone in your household is diagnosed with COVID-19 or being tested for COVID-19.

Your child has traveled to an area of high community transmission.

Select "Yes"to verify that all information on this form is correct to the best of your knowledge. *

Yes

Required

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