Southeast Portland Little League - Covid-19 Self Screening Survey

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This required self-screening survey is to help ensure that we are all doing our part as a community to limit the spread of Coronavirus. Please fill out the form and submit prior to participation of every practice and game.

Participant's First and Last Name *

Team Name *

Check the boxes for any of the following symptoms that your child has exhibited in the past 14 days. *

Chills

Congestion or Runny nose

Cough

Diarrhea

Fatigue

Fever

Headache

Loss of appetite

Loss of taste or smell

Muscle or body ache

Nausea or Vomiting

Shortness of breate

Sore Throat

None of the above

Required

Has the participant been in contact with anyone that has tested positive for Covid-19 or experienced symptoms in the past 14 days? * *

Yes

Has the participant had a fever of 100 degrees or above in the past 14 days? * *

Yes

If the participant is experiencing any possible Covid-19 symptoms, or has been exposed to somebody with Covid-19, we urge you to error on the side of caution and keep them home! Questions and/or concerns can be directed to our Safety Officer at safetyofficer@sepll.org

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