COVID Pre-Rehearsal Checklist
Please fill out the following survey prior to the start of each rehearsal.
If any responses are "YES" students/adults will NOT be allowed to practice/perform and will be asked to leave school grounds.
Temperatures will taken upon arrival.
Anyone with a temperature of 100.4 and over will be sent home.
First Name *
Last Name *
Grade (Chaps and staff answer Adult)
Have you had a fever today? *
Have you had chills today? *
Have you had a cough today? *
Have you had a sore throat today? *
Have you been short of breath today? *
Have you had loss of taste today? *
Have you had loss of smell today? *
Have you had vomiting today? *
Have you had diarrhea today? *
Within the past 14 days, have you been in close contact with someone who is currently sick with suspected or confirmed COVID-19? (Close contact is defined as within 6 feet for more than 10 consecutive minutes without PPE equipment.) *
Submit
Never submit passwords through Google Forms.
This form was created inside of Shikellamy School District. Report Abuse