SHS Athletics Daily COVID Health Survey

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Please answer all questions as accurately as possible before arriving to the school/building. This form MUST be completed prior to arriving to the school for athletic participation. Temperatures will be taken prior to the start of athletic participation daily.

Email *

Sport *

Football

Soccer - Boys

Soccer - Girls

Cross Country - Boys

Cross Country - Girls

Tennis - Girls

Field Hockey

Cheerleading

Weight Room

Other:

First Name *

Last Name *

Do you have any of these symptoms that are new, unexpected, or that you cannot attribute to another condition? (Please check off all that apply) *

Fever equal to or higher than 100.0 or feeling feverish (chills, sweating)

New Cough

Shortness of breath or difficulty

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore Throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

No symptoms

Required

Have you had close contact (within 6 feet for at least 10 minutes) with someone who has tested positive for COVID-19 in the past 14 days? *

Yes

Within the past 14 days, have you traveled to an area subject to a Level 3 CDC Travel Health Notice or to a U.S. state with significant COVID-19 spread, as identified by the NJ Department of Health? *

Yes

Are you under evaluation for COVID-19 (waiting for results of a viral test to confirm infection)? *

Yes

Have you been diagnosed with COVID-19 and not yet cleared to discontinue isolation? *

Yes

Please read the statement below.

If you've answered yes to any questions, stay home, notify your coach, Mrs. Franzwa and Mr. Clarke, and consult with your health care provider. Thank you!

A copy of your responses will be emailed to the address you provided.

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