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Cypress College Athletics

Covid-19 Screening Form

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Sport(s) Playing at Cypress College *
In recent days, have you experienced a fever? *
In recent days, have you experienced a cough? *
In recent days, have you experienced shortness of breath or difficulty breathing? *
In recent days, have you experienced chills or repeated shaking with chills? *
In recent days, have you experienced muscle pain? *
In recent days, have you experienced a headache? *
In recent days, have you experienced a sore throat? *
In recent days, have you experienced chest pain, palpitations, or fatigue? *
In recent days have you experienced new loss of smell or taste? *
Have you traveled internationally or from a location considered high risk for COVID-19 in the past 14 days? *
Have you been exposed in the last 14 days to anyone that has been diagnosed with COVID-19 or had COVID-19 symptoms? *
Have you had a documented elevated temperature (> 38 C, or 100 F) in the last 72 hours? *

IF YES TO ANY OF THE ABOVE QUESTIONS, PLEASE PROVIDE DETAILS AND CONTACT YOUR HEAD ATHLETIC TRAINER (OR HEALTHCARE PROVIDER IF NOT STUDENT-ATHLETE/ESSENTIAL STAFF)

I hereby acknowledge that the information provided is voluntary and will only be released reviewed by Cypress College Athletics staff. *
* required field