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COVID-19 Daily Screening for Visitors/Extracurricular
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* Indicates required question
Email
*
Your email
Name (First & Last)
*
Your answer
Phone Number
*
Your answer
Your Temperature:
*
Your answer
Question 2: Do you have any of the following symptoms?
*
I have none of the following symptoms
Fever (measured or subjective)
Chills
Rigors
Muscle Aches
Headache
Sore Throat
Nausea or Vomiting
Diarrhea
Fatigue
Congestion or Runny Nose
Required
Question 3: Do you have any of the following symptoms:
*
I have none of the following symptoms
Cough
Shortness of Breath
Difficulty Breathing
New Loss of Smell
New Loss of Taste
Required
Question 4: Have had close contact (within 6 feet of an infected person for 15 or more minutes during a 24 hr period) with a person with COVID-19
*
Yes
No
Question 5: Someone in your household is sick and is being evaluated, diagnosed or being tested for COVID-19
*
Yes
No
If your temperature is above 100.3, if TWO OR MORE of the fields in question 2 are checked off OR AT LEAST ONE field in question 3 is checked off, please stay home. If your answers are YES to question 4 or 5, please stay home. Please acknowledge:
*
I understand
I did not pass the covid screening and will not attend the event.
A copy of your responses will be emailed to the address you provided.
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