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COVID-19 Daily Screening Questions
To participate in practices/games, each student must complete this form daily before every practice/game. Screening questionnaires must be completed prior to arriving on school grounds.
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* Indicates required question
Email
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Grade Level 2020-2021
*
9 grader
10 grader
11 grader
12 grader
Parent/Guardian/Guest
Required
Sport
*
Boys Track
Girls Track
Baseball
Softball
Boys Volleyball
Boys Tennis
Golf
Boys Basketball
Parent/Guardian Cell
*
Your answer
Daily health status - Please answer the following questions below
Fever (Over 100.4)
*
Yes
No
Required
Cough or shortness of breath
*
Yes
No
Sore Throat
*
Yes
No
Chills
*
Yes
No
Muscle aches or rigors
*
Yes
No
Headache
*
Yes
No
New loss of taste or smell
*
Yes
No
Abdominal pain, nausea, vomiting or diarrhea
*
Yes
No
Have you had close contact (within 6 feet for 15 minutes or more during a 24 hour period) with a person with COVID-19?
*
Yes
No
If yes, what was the date of exposure?
MM
/
DD
/
YYYY
Have you been diagnosed with COVID-19?
*
Yes
No
If you answered Yes what was the date you were positively diagnosed with COVID-19?
MM
/
DD
/
YYYY
Has someone in your household been diagnosed with or being tested for COVID-19?
*
Yes
No
Have you traveled from any US state (outside of New York, Connecticut, Pennsylvania or Delaware) or internationally within the last 14 days?
*
Yes
No
If yes, what was the date of your return to NJ?
MM
/
DD
/
YYYY
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