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Outdoor Track Daily Screening Form
Student-athletes and Coaches: This screening form needs to be submitted by 1pm everyday prior to practice or competition.
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* Indicates required question
Student-Athlete or Coach Email Address
*
Your answer
Today's Date
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MM
/
DD
/
YYYY
Student-Athlete or Coach Full Name
*
Your answer
Day of the week
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please complete this short checklist by everyday prior to practice or competition. (Check all that apply)
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Temperature 100.4 degrees Farenheit or higher when taken by mouth.
Sore Throat.
New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline).
Diarrhea, vomiting or abdominal pain.
New onset of severe headache, especially with a fever.
None of the above
Required
Close Contact/Potential Exposure
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Had close contact (within 6 feet of an infected person for at least 15 minutes) with a person with confirmed COVID-19.
Traveled to outside of the United States in the 10 days.
None of the above.
Required
Are you currently testing for Covid-19 and/or waiting for test results.
*
Yes
No
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