Fall 2020 Cooper Self-Screening
This form must be completed every day that you attend an Cooper sponsored interscholastic practice, workout, game, or event.

If ALL of the questions below are answered NO, then the student-athlete or coach may enter the workout area for today's event.

If you answer YES to ANY of the questions below, please stay home, care for yourself, and contact your health provider with any worsening symptoms.
Email address *
Today's Date *
MM
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DD
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Your First and Last Name (No Nicknames Please!) *
What is your Activity today? Choose all sports or activities you are attending today. *
Required
Do you have a NEW or WORSENING cough or shortness of breath? *
Have you had a fever or cold symptoms in the previous 24 hours? *
Do you have at least two of the following symptoms: Fever (>100), chills, muscle pain, headache, sore throat, new loss of taste or smell? *
Required
Emergency Contact Name for TODAY - First and Last *
Emergency Contact Phone Number for TODAY *
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