COVID Screening Questionnaire

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**Valid October 20, 2020 +
Please fill this form out daily before your gymnast enters Bok for practice. Answer all questions honestly and careful - our goal is to error on the side of caution and thank you for helping our community stay safe and healthy!

Gymnast's Name: *

Today's date: *

YYYY

Does your child or anyone in the household have any of the following symptoms? Check all that apply. *

Cough

Shortness of breath

Difficulty breathing

Fever

Chills

Muscle aches / pain NOT related soreness from physical activity

Sore throat

New loss of taste or smell

None of the above

Required

Has your child or anyone in the household been exposed to anyone with a confirmed case of COVID-19 in the past 14 days? *

Yes

Unsure (please specify below)

Other:

Has your child or anyone in your household traveled or gone to any large gatherings within the past 14 days? *

Yes

Yes but we've either quarantined for 7 days and got a negative PCR Test on the 3-5th day after returning, or quarantined for 10 days and remained symptom free

Yes but I emailed in advance and got clearance to come

Other:

Is anyone awaiting a COVID test result that could be positive? *

Yes

Other:

Other thoughts or comments

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