Participant COVID Screening Form

Based on your response of “yes” to one of the questions, you are not permitted to participate, must stay home, notify the BMRC COVID Representative at [email protected], and are encouraged to contact your healthcare provider for assessment and testing.

Thank you for submitting your daily COVID-19 screening questionnaire, your response has been submitted.  You are permitted to participate today.

Please submit the following COVID-19 screening questions remotely prior to reporting to the site.  You must submit this form the day of the event and will not be permitted to participate until complete for the day and cleared to participate.   

Screen Questions
  1. Have you experienced any of the following symptoms of COVID-19 (or others as indicated by the CDC) in the past 14 days that are new and not usual? 
    • Fever of 100.4 degrees F or higher
    • Chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
  2. Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19 in the past 14 days? 
  3. Have you tested positive for COVID-19 in the past 14 days? 
  4. Are you currently required to quarantine or self-isolate by a health professional, government agency, or due to travel to a location requiring quarantine? 
Did you answer yes to any of the above questions?
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