Trumbull Youth Lacrosse --Health Check --Self-Screening Checklist - Fall 2020
The safety and well-being of our players and staff continue to be our highest priority. This self-screening daily checklist is part of our COVID-19 safety guidelines. Please answer each health question with a "Yes" or "No". In accordance with our guidelines, once you have completed and submitted this form you will receive an email with the screening results that must be presented to the athletic trainer or staff member at check-in prior to exiting your vehicle.
Email address *
Please enter your son/daughter's FIRST and LAST NAME. (You must fill out one form per child.) *
Grade level your son/daughter is currently in. *
Symptom Check - Please review the list of symptoms checking "Yes" if you have this symptom and "No" if you do not have the symptom. *
Yes
No
Fever or Chills
Nasal Congestion or Runny Nose
Sore Throat
Shortness of Breath or Difficulty Breathing
Diarrhea
Nausea or Vomiting
Fatigue
Headache
Muscle or Body Aches
New Loss of Taste or Smell
Fever (100 degrees or higher)
The requirement to self-quarantine and complete the Travel Health Form (https://appengine.egov.com/apps/ct/DPH/Connecticut-Travel-Health-Form) is applicable to any traveler who has spent twenty-four (24) hours or longer in an affected state within fourteen (14) days prior to arriving in Connecticut but does not include an individual remaining in Connecticut for less than twenty-four (24) hours. These requirements are also applicable to Connecticut residents who are returning from a visit to an affected state. The list of States as of September 1st are as follows: Alabama, Alaska, Arkansas, Florida, Georgia, Guam, Hawaii, Iowa, Idaho, Illinois, Indiana, Kentucky, Louisiana, Minnesota, Missouri, Mississippi, Montana, North Carolina, North Dakota, Nebraska, Nevada, Oklahoma, Puerto Rico, South Carolina, South Dakota, Tennessee, Texas, Utah, VirginIslands, Virginia, Wisconsin
How you been in close contact with any person who has recently been tested positive for COVID-19?
A copy of your responses will be emailed to the address you provided.
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