COVID-19 Screening Questionnaire

Are you or anyone you reside with currently ill or experiencing flu-like symptom?

Yes:___ No:___


Has anyone in the home been diagnosed with or presumed to have COVID19 within the past 30 days?

Yes:___ No:___


Has anyone in the home recovered from COVID-19 within the last 72 hours (Recovery is defined as resolution of fever without the use of fever reducing medications and improvements in respiratory symptoms)

Yes:____ No:___


Has anyone in the household (or an individual which they share domicile residence) traveled internationally or from a State on Governor Murphy’s Quarantine List within the past 14 days?

Yes:___ No:___


Has anyone in the home been self-quarantined or self-monitoring for COVID-19 within the past 14 days?

Yes:___ No:___


A “yes” response to any question means that player may not participate on that date.