COVID-19 SCREENING FALL CONTACT 2020
Email address *
ATHLETE FIRST NAME *
LAST NAME *
GENDER *
GRADE LEVEL *
Daily COVID-19 Symptom Screener
I do NOT have a fever over 100 degrees.
I do NOT have any of the following symptoms:
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- Recent loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
I have NOT had a positive COVID-19 test within the past ten days.
I do NOT live with anyone who tested positive for COVID-19 or anyone who is presumed positive for COVID-19 within the last 10 days.
I have NOT been asked to self-monitor, self-isolate, or self-quarantine by a public health or medical professional within the past 14 days.
I understand that I may be screened at random to ensure compliance with our enhanced safety measures.
I hereby certify that, before going to my athletic/activity session today, I have personally evaluated myself for the above symptoms of illness.
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