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Covid-19 Daily Pre-Screening Questionnaire Form
To participate in workouts and team practices during Plan C guidelines, each student and coach must complete this form daily before every workout, practice, or game. Screening questionnaires must be completed prior to arriving on school grounds.
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Email *
Email Address ( *
First Name *
Last Name *
Today's Date *
Sport *
Are you experiencing any of the following symptoms (Fever (> or = to 100.4, cough or shortness of breath, sore throat, chills, muscle aches or rigors, headache, new loss of taste or smell, abdominal pain, nausea, vomiting or diarrhea)? *
If yes, please list the symptoms experienced. If "No symptoms", please write "No".
Have you had close contact with someone who is currently sick?
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Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
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Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?
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Digital Signatures *
A copy of your responses will be emailed to the address you provided.
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