Student-Athlete COVID-19 Daily Screening Questionnaire

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电子邮件地址 *

Athlete Name: *

Sport *

Cross Country

Volleyball

Basketball

Have you had any of the following symptoms since your last screening? *

Yes

Cough

Shortness of Breath

Fever

Chills

Diarrhea

Runny Nose/Congestion

Nausea and/or vomiting

Body or Muscle Aches

Decreased sense of smell/taste

Sore Throat

Headache

Yes

Cough

Shortness of Breath

Fever

Chills

Diarrhea

Runny Nose/Congestion

Nausea and/or vomiting

Body or Muscle Aches

Decreased sense of smell/taste

Sore Throat

Headache

If you are experiencing any other symptoms, please list below and provide further details:

Have you traveled outside of your college sercie area within the past 14 days: *

yes

If yes, please explain below and provide details about location:

Have you been in direct contact with anyone who has tested positive for COVID-19, or has presumptive positive for COVID-19, since your last daily screening? *

Yes

If yes, please explain below and provide details about results and location:

Date *

日期

Time *

时间

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