2022 Girl Scouts of Eastern Missouri COVID-19 Protocol

You can find a fillable PDF of this form here.

COVID-19 Participant Screening Log This log can be used to track participants’ answers to the questions on the Participant Screening Tool. All COVID-19-related documentation, such as this log, should be securely retained for a minimum of 90 days after the Girl Scout activity for which they were completed.

Updated 5.7.2021

Meeting/Activity:

Date:

Time:

Name of Participant

Name of parent/caregiver of child, if applicable

Q 1

Q 2 Q 3 Q 4 Q 5 Q 6

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Name of Screening Volunteer/Staff Member:

Signature of Screening Volunteer/Staff Member:

Date: