CBC DAILY HEALTH QUESTIONNAIRE
All players MUST complete this questionnaire before EVERY event
DATE YOU FILLED THIS OUT
TIME YOU FILLED THIS OUT
PLAYERS LAST NAME
PLAYERS FIRST NAME
WHAT GRADE IS YOUR PLAYER IN?
WHICH HIGH SCHOOL ARE YOU ZONED FOR?
REQUIRED DAILY HEALTH CHECK QUESTIONS
Please review the following questions and respond below:
In the past 24 hours have you or anyone in your house had:
• A temperature of 100°F or above?
• New cough that cannot be attributed to another health condition?
• New shortness of breath that cannot be attributed to another health condition?
• New sore throat that cannot be attributed to another health condition?
• Gastrointestinal symptoms (diarrhea, nausea, vomiting) that cannot be attributed to another health condition?
• New nasal congestion or new runny nose?
• New loss of smell and or taste?
• New muscle aches?
• Any other sign of illness?
• Contact with someone in the previous 14 days with confirmed diagnosis of COVID-19 or someone who is ill with a respiratory illness?
DID YOU ANSWER "YES" TO ANY OF THE QUESTIONS ABOVE?
No - Time to play some hoops!
Yes - If so, you are NOT permitted to participate. You should not return until you or your family member is fever and symptom-free, without the use of medication for the fever or symptoms for three days.
A copy of your responses will be emailed to the address you provided.
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