COVID-19 Screening

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COVID-19 Screening - SLOBs

Service League of Boys

Event Name *

Event venue *

Event date *

YYYY

Full name *

Today's Date *

YYYY

Are you fully vaccinated? *

A person is “fully vaccinated” two weeks after completion of the entire recommended series of vaccination (usually one or two doses) with a vaccine authorized to prevent COVID-19 by the federal Food and Drug Administration, including by way of an emergency use authorization.

Yes

Decline to state

Required

1. Do you agree to wear a face covering at all times as required by mandate *

yes

Required

2. Have you had any of these symptoms in the last 10 days *

Fever, chills or sweating (temperature of 38 C / 100.4 F or higher)

Difficulty breathing

New or worsening cough

Sore throat

New or recent loss of taste or smell

Nausea, vomiting or diarrhea

None of the above

Have you tested positive for COVID-19 in the last 10 days? *

Yes

Have you had close contact with anyone who tested positive for COVID-19 within in the last 10 days *

Yes

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