COVID-19 STUDENT ATHLETE SELF-SCREENING QUESTIONNAIRE
In an effort to reduce the risk of COVID-19 exposure, all Clarkston Schools student athletes present on school grounds must complete the following daily screening questions.

An answer of “Yes” to any of these questions or if you have a temperture greater than 100.4 will exclude you from school grounds and contact Jeff Kosin, Shane Kerbelis or Kellie George immediately.

Screening checklist
https://www.oakgov.com/covid/supplements/!Compliance%20Toolkit%20-%20Health%20Order%2007.pdf

Symptoms of Coronavirus
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Sign in to Google to save your progress. Learn more
Email *
FIRST NAME *
LAST NAME *
What sport will be practicing? *
Date In the CCS Facility *
MM
/
DD
/
YYYY
Do you have any of the following symptoms: fever/feverish, chills, sore throat, dry cough, difficulty breathing, or digestive symptoms such as diarrhea, vomiting, and abdominal pain? *
In the past 14 days, have you been within 6 feet for 15 minutes with a person diagnosed with COVID-19? *
In the past 14 days, have you travelled internationally or outside the state of Michigan? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Clarkston.k12.mi.us. Report Abuse