Northwest Athletic COVID-19 Screening
COVID-19 Athlete/Coach Monitoring Form - This is a required form for all athletic activities until further notice. This form must be completed by all participants (coaches, athletes, etc.) for each event and will be saved to be used if necessary to move to the next phase and/or if issues arise for tracing purposes.
Anyone with positive responses on the screening tool and/or a temperature above 100 should STAY HOME and will NOT be allowed to take part in workouts and should contact their medical provider."
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First Name: *
Last Name: *
Today's Date: *
MM
/
DD
/
YYYY
Coach's Name: *
Facility (Check all that apply): *
Required
Check any of the symptoms you are currently experiencing.
If you are currently experiencing any of these symptoms, you may NOT practice or attend school or any athletic events until you are cleared by your healthcare provider. Please notify your school nurse. In order to return a physician's statement is required.
Do any of the following pertain to you?
If you checked "yes" to any of these questions, you may NOT practice or attend school or any athletic events until you are cleared by your healthcare provider. Please notify your school nurse. In order to return a physician's statement is required.
Temperature (if greater than 100, send participant home and check box below): *
If participant is sent home, please check the box below
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