Abington Athletics - Health Screening Form

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Spectators to Sports Contests must complete the Google Form to permit attendance.

Name *

Contact Phone Number *

Contact Email address *

Student-athlete *

Grade *

Sport *

Softball

Baseball

Boys Volleyball

Track and Field

Girls Lacrosse

Boys Lacrosse

Boys Tennis

Option 8

Contest Date *

TTTT

The questions below must be answered and submitted prior to attendance at athletic activities in Abington School District. If the answers to any of the questions below are YES, then you are required to stay home. *

I understand

Do you have a fever (temperature 100.4 or higher using oral thermometer; temporal 99.4 or higher)? *

Yes

Have you or anyone in the home tested positive for COVID-19 in the past 14 days? *

Yes

Have you or anyone in the home been in contact with someone who has tested positive for COVID-19 in the past 14 days? *

Yes

Have your or anyone in the home traveled to an affected geographic region in the past 14 days? (https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/Travel%20Order%20Amendment.pdf) *

Yes

Are you taking any medication to treat or reduce a fever such as Ibuprofen (i.e. Advil, Motrin) or Acetaminophen (Tylenol)? *

Yes

Using the chart below from the Department of Health Screening Tool updated August 13, 2020, are you experiencing 1 or more symptoms from Group A? *

Cough that cannot be explained by another diagnosis

Shortness of breath

Difficulty breathing

New Olfactory (smell) disorder

New taste disorder

No symptoms from Group A

Using the chart below from the Department of Health Screening Tool updated August 13, 2020, are you experiencing 2 or more symptoms from Group B? *

Fevers (measure or subjective)

Chills/Rigors

Myalgia (muscle pain or ache)

Headache

Sore Throat

Nausea or vomiting

Diarrhea

Fatigue

Congestion or runny nose

No symptoms from Group B

If the answers to any of the questions above are YES, you should stay home, and you may not attend the athletic event. *

I understand

By typing my name below, I agree that I will comply with the expectations found in the Abington School District Health & Safety Plan located at the following link: https://go.boarddocs.com/pa/abington/Board.nsf/files/BVVU5E739E4A/$file/Revised%20Health%20and%20Safety%20Plan%20for%20Sports%20and%20Activities.pdf. I agree to conduct a screening prior to entering the campus. *

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