COVID-19 Daily Pre-Screening Questions

To participate in workouts during the summer recess period, each student must complete this form daily before every workout. Screening questionnaires must be completed prior to arriving on school grounds.

You must answer NO to all of the questions below in order to submit this form. If your answer to any of the questions is YES, you may NOT attend the summer workout today.

Manasquan Student ID

Student's First Name

Student's Last Name

Parent/Guardian Cell Number


Are you experiencing any of the following symptoms?

1. Fever (≥ 100.4°F)
Yes No
2. Cough or shortness of breath
Yes No
3. Sore Throat
Yes No
4. Chills
Yes No
5. Muscle aches or rigors
Yes No
6. Headache
Yes No
7. New loss of taste or smell
Yes No
8. Abdominal pain, nausea, vomiting or diarrhea
Yes No

Have you had close contact with someone who is currently sick?
Yes No

Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
Yes No

Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?
Yes No

If you took your temperature this morning, what was the reading?

Correct the following errors before submitting:

  • Student ID is a required field.
  • Student First Name is a required field.
  • Student Last Name is a required field.
  • Parent/Guardian Cell is a required field.
  • All screening questions must be marked No.