Northeast DuPage Special Recreation Association

Participant Wellness Screening

NEDSRA Participant Wellness Screening
By arriving at a NEDSRA program, you are acknowledging that you have completed a participant wellness screening on behalf of the participant attending the program. Answering “No” to all NEDSRA Participant Wellness Screening questions verifies that the participant does not have any known COVID-19 symptoms.

If you answer “Yes” to any of the NEDSRA Participant Wellness Screening questions please do not attend the program. If the participant has an illness such as allergies or another non-contagious condition that may appear similar to COVID-19 symptoms please notify the program leader.

Participant Wellness Screening Questions
Y or N: Does the participant have a fever?

Y or N: Does the participant have a cough?

Y or N: Does the participant have a sore throat?

Y or N: Has the participant experienced difficulty breathing or a shortness of breath?

Y or N: Does the participant have muscle aches?

Y or N: Has the participant had a new or unusual headache (e.g., not related to caffeine, diet, or hunger, not related to history of migraines, clusters, or tension, not typical to the individual)?

Y or N: Has the participant had a new loss of taste or loss of smell?

Y or N: Has the participant experienced chills or rigors (rigors: a sudden feeling of cold with shivering accompanied by a rise in temperature)?

Y or N: Does the participant have any gastrointestinal concerns (e.g., abdominal, pain, vomiting, diarrhea)?

Y or N: Is anyone in your household displaying any symptoms of COVID-19?

Y or N: To the best of your knowledge, has the participant or anyone in your household come into close contact with anyone who has tested positive for COVID-19 {close contact includes household contacts, intimate contacts, or contact within 6-ft for 15 minutes or longer (10 minutes or longer for ambulatory care services) unless wearing N95 mask during period of contact}?

Follow-up
• A participant who is experiencing any of the symptoms on the screening should immediately notify the program leader by email and stay at home

• All sick participants with any symptoms are encouraged to seek a COVID-19 test at a state or local government testing center, healthcare center or other testing locations and follow guidelines recommended by the Health Department.

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