Football Covid-19 Questionnaire

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Students/Coaches should self-report as deemed necessary prior to each practice/event.
Temperature may be taken from a designated trained individual as needed. Symptoms should be marked as NO or Yes answers and be answered based off of the last 24 hours.

If any responses are “YES”, student will NOT be allowed to practice or compete, and will be asked to leave school grounds. Parent/Guardian will be notified.

Edwin *

Last Name *

Today's Date: (mm/dd/yy) *

Grade: *

Freshman

Sophomore

Junior

Senior

Coach/Staff

Have you had a fever or chills? *

Yes

Have you had a cough? *

Yes

Have you had a sore throat? *

Yes

Have you been short of breath? (Outside of normal exercise) *

Yes

Have you experienced loss of taste or smell? *

Yes

Have you experienced vomiting or diarrhea? *

Yes

Within the past 14 days have you had close contact with someone who is currently sick with suspected or confirmed COVID-19? (Note: Close contact is defined as within 6 ft for more than 10 consecutive minutes, without PPE equipment.) *

Yes

If you checked "yes" to any of the above symptoms, you are not permitted to practice or participate in games today and you inform your coaching staff IMMEDIATELY *

I understand

Required

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