Summer Activity 2020 COVID-19 Health Screen
With the ever-changing nature of COVID-19, there still remains the possibility of exposure. Since the Diocese has decided to “slowly” open up School Offices/Buildings, we want to be cautious of any such exposure. Therefore, we have established guidelines for a person to enter the building and/or attend activities on campus. You may continue to report to summer activities as long as you are able to honestly answer NO the following questions.

This form must be completed each time a person comes to campus. Upon arrival at the school, the completed form must be submitted.
Email address *
First Name *
Last Name *
Date *
At any time during the activity, persons should remove themselves from any situation where they feel unsafe and report same to your coach or Camp Director. *
What is your current temperature? *If above 100 degrees, please do not report to campus. *
Do you currently have any of the following symptoms?
Please answer Yes or No to all of the following questions. If you answer Yes to any of the questions, please do not report to campus and notify your coach or Camp Director immediately.
Cough *
Difficulty Breathing/Shortness of Breath *
Fever *
Sore Throat *
Loss of Taste and/or Smell *
Chills *
Muscle Pain *
Have you or someone in your household, had close, unprotected contact with a suspected or known COVID-19 patient (spent longer than 15 minutes within 6 feet of someone who was sick with a fever and cough) in the past 14 days? *
Name of person completing Health Screen of this student *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Catholic High School. Report Abuse