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COVID-19 Daily Pre-screening Questions
To participate in workouts, each student must complete this form daily before every workout. Screening questionnaires must be completed prior to arriving on school grounds.
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* Indicates required question
Full Name
*
Your answer
Date:
*
MM
/
DD
/
YYYY
Parent/Guardian Cell:
*
Your answer
Sport:
*
Coach
Cross Country
Football
Boys Soccer
Girls Soccer
Girls Tennis
Girls Volleyball
Are you experiencing any of the following symptoms?
Your answer
Fever equal to or greater than 100.4°F? *
*
Yes
No
Cough or shortness of breath? *
*
Yes
No
Sore throat?
*
Yes
No
Chills?
*
Yes
No
Muscle aches or rigors (not related to sports)?
*
Yes
No
Headache?
*
Yes
No
New loss of taste or smell?
*
Yes
No
Have you had close contact with someone who is currently sick?
*
Yes
No
Abdominal pain, nausea, vomiting, or diarrhea?
*
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 traveled or had close contact with anyone who has traveled internationally in the last 14 days?
*
Yes
No
If you took your temperature this morning, what was the reading?
*
Your answer
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