Covid-19 Daily Screening Questions

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You MUST fill out this form each time you attend practice/conditioning/weight training/ or competition with Bergen Tech Athletics.

IMPORTANT: Please fill out for as you arrive to practice. Do not SEND until you show the screener that you entered all NO's and the screener takes your temperature. You will then enter your temp on the last question and hit SEND.

If you are answering "YES" to any of these questions, DO NOT report to your activity. All travel, exposure, and/or symptoms of COVID-19 must be reported to your school nurse immediately.

First Name *

Last Name *

Sport *

Have you had a fever in the last 24 hours? *

Yes

Have you had a cough in the last 24 hours? *

Yes

Have you had a sore throat in the last 24 hours? *

Yes

Have you had shortness of breath in the last 24 hours? *

Yes

Have you had chills in the last 24 hours? *

Yes

Have you had muscle aches or rigors in the last 24 hours? *

Yes

Have you had a headache in the last 24 hours? *

Yes

Have you had a lost of taste or smell in the last 24 hours? *

Yes

Have you had abdominal pain, nausea, vomiting or diarrhea? *

Yes

Have you had close contact or cared for someone with Covid-19 in the past 3 weeks? *

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 recently traveled to an area of high community transmission. Answer YES or NO. If you answer YES, indicate your travel dates. https://covid19.nj.gov/faqs/nj-information/travel-and-transportation/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey *

Enter Temperature after Coach/Athletic Trainer/Screener takes it at practice/event. *

As a reminder, participating in any activities or gatherings that may put you at risk for coming in contact with Covid-19 it is your choice but Bergen Tech Athletics wants to remind you that the risk you're willing to take could shut your entire team down for two weeks or longer. Please keep your teammates who are adhering to the NJSIAA/NFHS/Bergen Tech Athletic Protocols and Guidelines in mind. Our ultimate goal is to have a fall season and we need all athletes doing their very best to help make that possible.

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