Covid-19 Student Athlete Monitoring Form

Covid-19 Student Athlete Monitoring Form

Daily Questionnaire - Hockey

* Required

Name (First and Last) *

Your answer

In the past 72 hours, have you had any of the following symptoms:

Fever or Chills? *

1 point

Yes

No

Cough? *

1 point

Yes

No

Sore Throat? *

1 point

Yes

No

Congestion or Runny Nose? *

1 point

Yes

No

Shortness of Breath? *

1 point

Yes

No

Body/Joint/Muscle Aches? *

1 point

Yes

No

Headache? *

1 point

Yes

No

Vomiting/Nausea/Diarrhea? *

1 point

Yes

No

Loss of Taste/Smell? *

1 point

Yes

No

Have you traveled out of state in the past 14 days? *

1 point

Yes

No

Have you come into contact with someone with Covid-19 in the past 14 days? *

1 point

Yes

No

Submit

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy