COVID-19 Daily Pre-screening Questions
To participate in WDMB rehearsals during the summer recess period each student must complete this form prior to every rehearsal. Screening questionnaires must be completed prior to arriving on school grounds.
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Student's Name *
Last name, First name
Today's Date *
MM
/
DD
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YYYY
Parent/Guardian's Name *
Parent/Guardian Cell Phone Number *
Are you experiencing a fever >100.4 today? *
Are you experiencing Cough or shortness of breath? *
Are you experiencing Sore Throat? *
Are you experiencing Chills? *
Are you experiencing Muscle aches or rigors? *
Are you experiencing Headache? *
Are you experiencing New loss of taste or smell? *
Are you experiencing Abdominal pain, nausea, vomiting or diarrhea? *
Have you had close contact with someone who is currently sick? *
Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19? *
Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days? *
If you took your temperature this morning, what was the reading? *
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