Troop 483 COVID Screening Questionaire

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The intent of this checklist is to review with each youth and adult participant their current health status, both before departure and upon arrival at the event, and to identify potentially communicable diseases. Anyone entering meeting or event—including scouts, parents, leaders—will be screened using this checklist.

First Name *

Last Name *

Date *

YYYY

Event Name *

Patrol/Role *

#1 - Have you been in close contact with anyone who has or had COVID-19, or another known communicable disease outbreak, in the last 14 days? *

Yes

If the answer is yes, the participant must stay home.

#2 - Are you in a higher-risk category as defined by the CDC guidelines? *

Yes

If the answer is yes, we recommend that you stay home. Should you decide to participate, you must have approval from your healthcare provider and then proceed to the symptom decision tree below.

#3 - Have you completed your COVID-19 “At Risk” Activity Participation Statement? *

Yes

If the answer is yes, bring the completed form to the activity. (unless already on file)

#4 - Have you completed the Parental Commitment to Transport form? *

Yes

If the answer is yes, bring the completed form to the activity. (unless already on file)

Do you have a fever above 100.4 degrees? * *

Yes

Time entering scouting event *

Time

If the above answers to #1 and #2 are “no,” proceed to this symptom decision tree.

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