Request edit access
SHS Athletics Daily COVID Health Survey
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 address *
Sport *
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) *
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? *
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? *
Are you under evaluation for COVID-19 (waiting for results of a viral test to confirm infection)? *
Have you been diagnosed with COVID-19 and not yet cleared to discontinue isolation? *
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.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Pittsgrove Township Schools. Report Abuse