Covid | Questionaire


Today’s Date: ______________________    Time of Session: ________________

 

Coaches Name (maximum 2 coaches):

 

____________________    ____________________



Participating Players First names and Last name initial (Maximum 6 players)

 

____________________    ____________________    __________________

 

____________________    ____________________    __________________

 

Player questionnaire before starting each session:

Do you have any of the following symptoms?

  • Cough
  • Fever
  • Shortness of Breath
  • Sore Throat
  • Loss of smell or taste
  • Generally feeling unwell including but not limited to fatigue, muscle or joint pain, nausea, vomiting and / or diarrhea

 

Do you live with or have had close contact (within 2 meters/6 feet) with someone who is ill with fever and/or cough and ILI symptoms? 

 

Do you live with or have had close contact (within 2 meters/6 feet) with a person with an influenza-like illness (ILI)? 

 

Have you had close contact (within 2 meters/6 feet) with a confirmed or probable case of COVID-19?

If a player answers yes to any of the above questions, coaches must immediately execute the AHS protocol as outlined on the document posted at Clear Water Academy.

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