Student Daily COVID-19 Symptom Self Screening
Please fill out this form each day you are scheduled to be in class at EDS.
Email address *
Today's Date *
MM
/
DD
/
YYYY
Dancer First Name *
Dancer Last Name *
Have you had a fever in the last 24 hours? *
Have you had any recent known exposures to someone who tested positive for COVID-19? *
Have you had any of the following symptoms: *
Yes
No
Fever and Chills?
Cough?
Shortness of Breath?
Fatigue?
Muscle or Body Aches?
Headache?
New loss of taste or Smell?
Sore Throat?
Congestion or Runny Nose?
Nausea or Vomiting?
Diarrhea?
Did you answer Yes to any of the above questions? *
Have you taken any medications consisting of ibuprofen (advil, motrin), naprosyn (Aleve, menstridol), aspirin, acetaminophen (tylenol) in the last 8 hours? *
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