Athletic Event COVID-19 Screening Questionnaire
Below are screening questions for possible COVID-19 symptoms. If you should answer yes to any of the questions below you will not be permitted to be on any LISD facility. Media, officials, and concession workers are required to complete this form each time they attend/work an LISD athletic event. LISD employees that have already self screened for the day are not required to complete this.
Email address *
Last Name *
First Name *
Phone Number *
Date *
What LISD facility is the event in which you are attending? *
What sport are you attending? *
What role are you serving at the event? *
1. Have you have recently had any contact with anyone that is/has tested positive for COVID-19? 2. Do you have a new or worsening cough or shortening of breath/difficulty breathing? 3. Do you have a fever? (subjective or greater than 100 degrees F) 4. Do you have any of the following symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell or diarrhea? *
Never submit passwords through Google Forms.
This form was created inside of Report Abuse