Cross Country Student Health Screening
Complete this form prior to returning to school for any activities.
Student First Name *
Student Last Name *
Symptoms
Do you have any of the following new or worsening symptoms of possible COVID-19?
* New uncontrolled cough that causes difficulty breathing (or, for students with a chronic allergic/asthmatic cough, a change in their cough from baseline)
* Diarrhea
* Vomiting
* Abdominal Pain
* Sore Throat
* Loss of taste or smell
* New onset of severe headache, especially with a fever
* Muscle pain
* Chills
* Repeated shaking with chills
* Shortness of breath or difficulty breathing
* Temperature of 100.4 degrees Fahrenheit or higher when taken by mouth
* Known close contact with a person who is lab-confirmed to have COVID-19
Do you have any of above symptoms of possible COVID-19? *
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