Self-Screening Form

Each participant is required to self-screen for COVID-19 symptoms before each SOS in-person function by responding to the questions below; this includes taking their own temperature and signing the acknowledgement at the bottom.

If you are experiencing any symptoms of COVID-19 including:

· Fever of greater than 100.4°F

· Dry cough

· Shortness of breath

· Chills

· Muscle aches / pain

· Sore throat

· Nausea/vomiting or Diarrhea

· Fatigue / malaise

· Recent inability to taste or smell

DO NOT ATTEND, isolate yourself from other family members, and call your medical provider.