TYL Spring '21 Health Screener Form
The safety and well-being of our players and staff continue to be our highest priority. This self-screening daily checklist is part of our COVID-19 safety guidelines. Please answer each health question with a "Yes" or "No". In accordance with the CDC guidelines, once you have completed and submitted this form you will receive an email with the screening results that must be presented to the athletic trainer or staff member at check-in prior to exiting your vehicle.
Email address *
What is today's date? *
MM
/
DD
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YYYY
Please enter your son/daughter's LAST NAME. (You must fill out one form per child.) *
Please enter your son/daughter's FIRST NAME. (You must fill out one form per child.) *
Grade level your son/daughter is currently in. *
Has anyone in your household experienced any of these symptoms in the last 72 hours? *
Yes
No
Fever or Chills
Nasal Congestion or Runny Nose
Sore Throat
Shortness of Breath or Difficulty Breathing
Diarrhea
Nausea or Vomiting
Fatigue
Headache
Muscle or Body Aches
New Loss of Taste or Smell
Fever (100 degrees or higher)
In the last 10 days, has anyone in your household *
Yes
No
Had a confirmed COVID-19 case?
Had close contact with anyone with a suspected or confirmed case of COVID-19?
Been tested or advised to be tested due to a known/suspected exposure to COVID-19?
Been advised or directed to quarantine or self-isolate due to COVID-19?
Is anyone in your household: *
Yes
No
Supposed to be quarantining/remaining out due to domestic or international travel?
Awaiting COVID-19 test results?
Going to be tested for COVID-19 in the next 24 hours?
A copy of your responses will be emailed to the address you provided.
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