COVID-19 Screening Form

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Player Name *

School you attend: *

Have you experienced any of the following symptoms in the past 48 hours? *

fever or chills

cough

shortness of breath or difficulty breathing

fatigue

muscle or body aches

headache

new loss of taste or smell

sore throat

congestion or runny nose

nausea or vomiting

diarrhea

none

Required

Have you been in close physical contact in the last 14 days with: *

Anyone who is known to have laboratory-confirmed COVID-19?

Anyone who has any symptoms consistent with COVID-19?

None

Required

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are you worried that you may be sick with COVID-19? *

Yes

Are you currently waiting on the results of a COVID-19 test? *

Yes

Have you traveled in the past 10 days? Travel is defined as any trip that is overnight AND on public transportation, OR any trip that is overnight AND with people who are not in your household. *

Yes

I certify that my responses are true and correct. *

Yes

Required

Submit

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