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.
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:
Updated 5.7.2021