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COVID-19 Athlete/Coach Monitoring Form
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Grade
*
Choose
5
6
7
8
9
10
11
12
FEVER
*
YES
NO
COUGH
*
YES
NO
SORE THROAT
*
YES
NO
SHORTNESS OF BREATH
*
YES
NO
CLOSE CONTACT OR CARED FOR SOMEONE WITH COVID-19
*
YES
NO
TEMPERATURE (HIGHER THEN 100.3 F IS DANGEROUS)
*
Your answer
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