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Monroe High School Daily Covid-19 Screening Form
Coaches and players need to sign in daily to complete the required Covid-19 Screening.
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* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Name of person completing this form.
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Student's Daily Temperature
*
Your answer
Does your student have a fever greater than or equal to 100 degrees or fever symptoms of chills alternating with sweating?
*
Yes (must stay at home until fever free without fever reducing medication for 3 days)
No (continue to the next question)
Has your student traveled outside Alaska within the past 14 days?
*
Yes (be sure to follow state mandates regarding travel
https://covid19.alaska.gov/travelers/
)
No
Have you or someone in your household, had close unprotected contact with a known COVID-19 patient (spent more than 10 minutes within 6 feet of someone who was sick with a fever and cough)?
*
Yes (must quarantine for 14 days without symptoms before returning)
No (continue to next question)
Does your student have any of the following symptoms?
*
Cough
Trouble breathing, shortness of breath, wheezing
Chills
Muscle Aches
Sore Throat
Headache
Loss of Smell and/or Taste
None (you may participate if no symptoms)
Required
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