COVID-19 Screening
At-home screening to be performed and recorded daily prior to entering any sports medicine facility.
Sign in to Google to save your progress. Learn more
Email *
Last name, First name, Grade
Have you been diagnosed with COVID-19? *
Are you, or someone in your household, pending a covid-19 test? *
Have you experienced symptoms of COVID-19? *
Have you had close contact, or cared for someone with COVID-19? *
Do you have a fever? *
Do you have a cough? *
Do you have a sore throat? *
Are you experiencing shortness of breath? *
Are you experiencing a loss of taste or smell? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Governor Mifflin School District. Report Abuse