COVID-19 Pre-Screen Daily Symptom Questionnaire
This form is to be completed and submitted by each student prior to leaving home for campus on each rehearsal day. The form will begin accepting responses at 6:15am each rehearsal day. If you do not complete and submit this form at home, you will be required to do so at the Pre-Screen Check-in area prior to being permitting into the facility. Thank you
Your Student ID Number (xxxxxx)
Your Marching Instrument
Your Cell Phone Number (xxx-xxx-xxxx)
Current Body Temperature
Please select all of the symptoms below that you have experiences within the past 24 hours.
Shortness of breath or difficulty breathing
Loss of taste or smell
Feeling feverish or temperature above 99.9 degrees
None of the above
Have you been in close contact with anyone who has tested positive for COVID-19?
A copy of your responses will be emailed to the address you provided.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Mansfield ISD.