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Student Daily COVID-19 Symptom Self Screening
Please fill out this form each day you are scheduled to be in class at EDS.
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Dancer First Name
*
Your answer
Dancer Last Name
*
Your answer
Have you had a fever in the last 24 hours?
*
Yes
No
Have you had any recent known exposures to someone who tested positive for COVID-19?
*
Yes
No
Have you had any of the following symptoms:
*
Yes
No
Fever and Chills?
Cough?
Shortness of Breath?
Fatigue?
Muscle or Body Aches?
Headache?
New loss of taste or Smell?
Sore Throat?
Congestion or Runny Nose?
Nausea or Vomiting?
Diarrhea?
Yes
No
Fever and Chills?
Cough?
Shortness of Breath?
Fatigue?
Muscle or Body Aches?
Headache?
New loss of taste or Smell?
Sore Throat?
Congestion or Runny Nose?
Nausea or Vomiting?
Diarrhea?
Did you answer Yes to any of the above questions?
*
Yes
No
Have you taken any medications consisting of ibuprofen (advil, motrin), naprosyn (Aleve, menstridol), aspirin, acetaminophen (tylenol) in the last 8 hours?
*
Yes
No
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