COVID-19 Screening Form

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In order to access Iraan-Sheffield ISD facilities, all groups must provide the following information.

Please respond to each item and then submit.

Please ensure that you check the temperature of the athletes, students, coaches, teachers, administrators and all staff prior to traveling to ISISD.

Please ensure that you click on the following link and review the information available in the guide and page 14 for COVID-19 Symptoms. Link: https://drive.google.com/file/d/1syZv62GUYa3EOR016UizTNYMUmD5yDG7/view and https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

If you, or anyone on your team or in your group, have one or more of the items listed below, you will NOT be permitted access to ISISD facilities.

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E-Mail-Adresse *

First and Last Name: *

Cell Phone Number: *

Your School District: *

Date of Event: *

JJJJ

Times of Event: *

Event: *

1. I have checked the temperature of myself and everyone on my team and in our group within the last 24 hours and we do NOT have a fever. *

True

False

Pflichtfrage

2. Noone on our team, or in our group, has a cough, difficulty breathing, shortness of breathe or other COVID-19 symptom as described by the CDC? (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) *

True

False

3. 14 days have passed since I, or anyone in my group, has had a fever (or other COVID-19 Symptom as described by the CDC). *

True

False

4. Myself, nor anyone on our team, or in our group, has persistent pain, or pressure in the chest as described by the CDC. *

True

False

5. Myself, nor anyone on our team, or in our group, has come in close contact with or traveled internationally within the past 14 days. *

True

False

By submitting this form, I attest that all of the information provided is true and accurate to the best of my knowledge. *

True

False

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