Covid-19 Student Athlete Monitoring Form
Daily Questionnaire - Hockey
Name (First and Last) *
In the past 72 hours, have you had any of the following symptoms:
Fever or Chills? *
1 point
Cough? *
1 point
Sore Throat? *
1 point
Congestion or Runny Nose? *
1 point
Shortness of Breath? *
1 point
Body/Joint/Muscle Aches? *
1 point
Headache? *
1 point
Vomiting/Nausea/Diarrhea? *
1 point
Loss of Taste/Smell? *
1 point
Have you traveled out of state in the past 14 days? *
1 point
Have you come into contact with someone with Covid-19 in the past 14 days? *
1 point
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