COVID-19 CONTACT DAYS questionnaire

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A questionnaire that should be filled out before a team pod meets up to determine if anyone has symptoms of COVID-19.

First Name *

Last Name *

Which contact day sport are you attending? *

Boys Baseball

Boys Basketball

Boys Gymnastics

Boys Volleyball

Boys Football, Track, Wrestling

Girls Basketball

Girls Soccer

Girls Softball

Required

Are you experiencing a fever, cough, chills, and/or muscle aches? *

Yes

Are you experiencing a sore throat, runny nose, and/or loss of taste or smell? *

Yes

Are you experiencing nausea, vomiting, and/or diarrhea? *

Yes

Are you experiencing shortness of breath and/or headaches? *

Yes

Have you been in close contact or cared for someone with COVID-19 in the last 14 days? *

Yes

If you put yes for any of the above questions please explain:

If you put yes for any questions please stay home until the athletic trainer or coach contacts you to discuss further. Thank you and Stay Well!!

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This form was created inside of Maine Township High School District 207.

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