COVID-19 Questionnaire

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Please complete this short check each morning and report your child's information per your school's reporting instructions

Student athlete last name *

Student athlete first name *

Campus *

Piscataway

Sport *

Softball

Section 1: Symptoms

Any of the symptoms below could indicate a COVID-19 infection in children and may put your child at risk for spreading illness to others. Please note that this list does not include all possible symptoms and children with COVID-19 may experience any, all, or none of these symptoms. Please check your child daily for these symptoms:

Column A

Fever (measured or subjective)

Chills

Rigors (shivers)

Myalgia (muscle aches)

Headache

Sore throat

Nausea or Vomiting

Diarrhea

Fatigue

Congestion or runny nose

Column B

Cough

Shortness of breath

Difficulty breathing

New loss of smell

New loss of taste

Students who are sick (e.g. fever, vomiting, diarrhea) should not attend school in-person. If TWO OR MORE of the fields in Column A or AT LEAST ONE field in column B is checked off, please keep your child home and notify the school for further instructions.

Section 2: Close Contact/Potential Exposure

Please verify if in the last 14 days:

Your child has had close contact (within 6 feet of an infected person for 15 or more minutes during a 24-hour period) with a person with COVID-19

Someone in your household is diagnosed with or being tested for COVID-19

Your child has traveled from any U.S. State or territory outside of New York, Connecticut, Pennsylvania, and Delaware and is not otherwise exempt from quarantine under the DOH travel restrictions

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