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COVID-19 Daily Pre-Screening Questions

  1. COVID-19 Daily Pre-Screening Questions

  2. To participate in Recreation activities, each student must complete this form daily before their scheduled tryout, practice or game. Screening questionnaires must be completed and submitted prior to arriving at any Recreation activity. * Required

  3. STUDENT ATHLETE INFORMATION

  4. SYMPTOMS SCREENING

  5. Are you experiencing any of the following symptoms?

  6. Temperature of 100.4°F or higher*

  7. Cough or shortness of breath*

  8. Sore throat*

  9. Chills*

  10. Muscle aches or rigors*

  11. Headache*

  12. New loss of taste or smell*

  13. Abdominal pain, nausea, vomiting, or diarrhea*

  14. RECENT HISTORY REVIEW:

  15. Please respond to each of the following questions.

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

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

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

  19. TRAVEL ADVISORY QUARANTINE (**LIST FREQUENTLY UPDATED**) Please note that the Governor's Office has issued a 14-Day Travel Advisory Quarantine that applies to anyone arriving in New Jersey from any of the states identified on the list found at the website linked below:

  20. **THESE STATES ARE SUBJECT TO CHANGE. PLEASE REVIEW THE LIST CAREFULLY EACH TIME YOU RESPOND TO THIS QUESTION**

  21. Have you traveled back to New Jersey from any of the states listed above within the past 14 days? **

  22. Leave This Blank:

  23. This field is not part of the form submission.