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Heritage High School Player COVID 19 Screening Checklist
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* Indicates required question
Player Name
*
Your answer
Date of conditioning session:
*
MM
/
DD
/
YYYY
Do you have a fever?
*
Yes
No
Do you have a cough?
*
Yes
No
Do you have a sore throat?
*
Yes
No
Are you experiencing shortness of breath?
*
Yes
No
Have you been in close contact with or cared for someone with Covid 19 in the last 14 days?
*
Yes
No
Temperature
*
Your answer
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