COVID-19 Daily Pre-screening Questions

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All preseason and remote learners must complete this form daily before every workout prior to arriving on school grounds. On a day that school is not in session all athletes must complete this form prior to arriving to practices/games.

Name of Student *

Date *

YYYY

Sport *

Parent/Guardian Cell *

Are you experiencing any of the following symptoms? Fever (≥ 100°F) *

Yes

Are you experiencing any of the following symptoms? Cough or shortness of breath *

Yes

Are you experiencing any of the following symptoms? Sore Throat *

Yes

Are you experiencing any of the following symptoms? Chills *

Yes

Are you experiencing any of the following symptoms? Muscle aches or rigors *

Yes

Are you experiencing any of the following symptoms? Headache *

Yes

Required

Are you experiencing any of the following symptoms? New loss of taste or smell *

Yes

Are you experiencing any of the following symptoms? Abdominal pain, nausea, vomiting or diarrhea *

Yes

Have you had close contact with someone who is currently sick? *

Yes

Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19? *

Yes

Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days? *

Yes

Have you traveled outside of the state of New Jersey in the previous 10 days? *

Yes

Vaccination Status (for contact tracing purposes) *

Please take your temperature prior to leaving for Stuart and record below. *

Submit

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