Athletic COVID-19 Daily Self Assessment

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Please fill out this form prior to each practice returning to campus every morning.
Source https://www.mayoclinic.org/covid-19-self-assessment-tool

Email *

What sport are you playing?

Soccer

Basketball

Football

First & Last Name *

Have you been within 6 feet of a person with a lab-confirmed case of COVID-19 for at least 5 minutes, or had direct contact with their mucus or saliva, in the past 14 days? *

Yes

In the last 48 hours, have you had any of the following NEW symptoms? Check all that apply. *

Fever of 100 F (37.8 C) or above, or possible fever symptoms like alternating chills and sweating

Cough

Trouble breathing, shortness of breath or severe wheezing

Chills or repeated shaking with chills

Muscle Aches

Sore Throat

Loss of smell or taste, or a change in taste

Nausea, vomiting or diarrhea

Headache

None of the above

Required

Has a public health official advised you to get tested for COVID-19? *

Yes

Required

If you are feeling ill it is your responsibility to report it to the Athletic Director. By doing so, you are keeping our community safe. *

I understand and will report if I feel ill to the Athletic Director.

Required

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