Pack 351 in-person event COVID pre-screening: please fill this form out per family, assuming all family members have the same exposure and symptoms.

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Use this checklist to assist in identifying potential COVID-19 cases before event participation.

(Recommendations say: This form must be filled out for each youth and adult participant regarding his/her current health status, both before departure and upon arrival at the event. Anyone entering a camp or event-including visitors-must be screened.)

(According to the Centers for Disease Control and Prevention (CDC), "close contact" means:
1. You were within 6 feet of someone who has COVID-19 for a cumulative total of 15 minutes or more over a 24-hour period.
2. You had direct physical contact with an infected person (hugged or kissed them)
3. You shared eating or drinking utensils
4. An infected person sneezed, coughed, or otherwise got respiratory droplets on you.)

Email *

Today's date and event you are attending:

Names of participants

Phone number

Have you or has anyone in your household been in close contact in the past 14 days with anyone known or suspected to have COVID-19 or is otherwise sick?

Yes

Clear selection

Have you or has anyone in your household been in close contact with anyone who has been tested for COVID-19 and is waiting for results?

Yes

Clear selection

Have you or has anyone in your household been sick in the past 14 days, or have you or they been tested for any illness and are waiting for results?

Yes

Clear selection

Has anyone in your household been exposed to an individual know or suspected to have COVID-19 in the past 14 days?

Yes

Clear selection

Has you or has anyone you have been in close contact with traveled on a cruise ship or internationally or to an area with a know communicable disease outbreak in the past 14 days?

Yes

Clear selection

Did you answer YES to any of the above questions?

Yes: YOU MUST STAY HOME

No: Continue to the next question

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If you answered NO to the previous question: Does anyone in your house have the following symptoms? If yes to ANY of them, YOUR ENTIRE HOUSEHOLD MUST STAY HOME.

Shortness or breath

Cough

Fever of 100.0 degrees or greater

Flu-like symptoms

Repeated shaking with chills

Fatigue

Muscle or body aches

Headache

Sore throat

Loss of taste or smell

Diarrhea

Nausea or vomiting

Are you in a higher-risk category as defined by the CDC guidelines, including older adults, people with medical conditions, and those with other individual circumstances?

Yes: We recommend that you stay home. Should you choose to participate, you must have approval from your health care provider.

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Are you aware that you could come in contact with an asymptomatic individual who is infectious with COVID at this meeting?

Yes

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Are you aware that if you contract COVID-19 you are infectious 48 hours prior to first symptoms?

Yes

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Do you agree to notify us if anyone in your family develops symptoms or tests positive within 48 hours of the activity?

Yes

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