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CMS Cross Country COVID-19 Daily Pre-screening Questions
This form must be completed each day prior to participation in any Fall Sports program. A doctor's note will be required for any YES responses to the following questions.
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Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Grade
*
Choose
6
8
7
Today's Date
*
MM
/
DD
/
YYYY
Phone #
*
Your answer
Sport - Choose One
*
Choose
Boys Cross Country
Girls Cross Country
Are you experiencing a fever greater than or equal to 100.4?
*
Yes
No
Are you experiencing a cough or shortness of breath?
*
Yes
No
Are you experiencing a sore throat?
*
Yes
No
Are you experiencing chills?
*
Yes
No
Are you experiencing muscle aches or rigors?
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Yes
No
Are you experiencing a headache?
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Yes
No
Are you experiencing a new loss of taste or smell?
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Yes
No
Are you experiencing abdominal pain, nausea, vomiting, or diarrhea?
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Yes
No
Have you had close contact with someone who is sick?
*
Yes
No
Have you been diagnosed with COVID-19 in the past three weeks?
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Yes
No
Do you have reason to believe that you have COVID-19?
*
Yes
No
Have you traveled or had close contact with someone who has traveled internationally in the past 14 days?
*
Yes
No
If you took your temperature this afternoon, what was the reading?
Your answer
A copy of your responses will be emailed to the address you provided.
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