Daily Self Screening Assessment

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Members must sign written attestations 30 minutes prior to the start of in person boot camp training (by 6:00pm), regarding COVID-19 symptoms, exposure to COVID-19, and travel to high risk states. Any member who hasn't submitted a completed screening questionnaire by this timeline, will not be permitted to participate in training. (If I haven't received your screening by 6:00pm, you'll not be permitted in class. It's for the safety of everybody.)

https://www.mass.gov/info-details/safety-standards-and-checklist-fitness-centers-and-health-clubs

Which class time? *

6:30pm, Tuesday

Required

Full Name *

Today or in the past 24 hours, have you had any of the following? Please note that if you have any of the first 7 symptoms (fever through muscle aches), you must not come to in person boot camp. If you have any of the last 4 symptoms (fatigue through any other sign of illness) in combination with any of the first 7 symptoms, you must not come to training until 72 hours symptom free. You will be monitored for all of these symptoms throughout your workout. *

Fever (100.4 f or higher), felt feverish or had chills

Cough

Sore Throat

Rapid Breathing or Difficulty Breathing (without recent physical activity)

Gastrointestinal distress (nausea, vomiting or diarrhea)

New loss of taste or smell

New muscle aches

Fatigue

Headache

Runny nose or congestion

Any other sign of illness

Contact with someone in the previous 14 days with a confirmed or presumptive diagnosis of COVID-19 or someone who is ill with a respiratory illness?

No, I do not have any of the above symptoms.

Required

Do any other members of your household have the above symptoms? *

Yes

If yes, who? What signs/symptoms are they experiencing and for how long?Your answer

Have you taken any fever reducing medications in the past 24 hours? *

Yes

If you have been exposed to an individual who is COVID-19 positive, then you may NOT return to in person boot camp for 14 days and you should actively monitor your temperature and watch your symptoms. *

I understand and will abide by this to the best of my ability.

Required

If you have symptoms but you HAVE NOT been exposed to an individual who is COVID-19 positive, then you may NOT return to in person boot camp until you are symptom and fever free without the use of medication for 72 hours. *

I understand and will abide by this to the best of my ability.

Travel outside of Massachusetts other than to low risk states (currently Connecticut, Maine, New Hampshire, New Jersey, New York and Vermont) requires quarantining for 14 days or a negative COVID test result which you should provide to me, Coach Mike. (I ask that you let me know if work or family obligations will require you to travel to a high risk state or outside of the country during your boot camp membership.)

Please click here if you have traveled to a high risk state or outside of the country within the past 14 days.

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By electronically signing below, I attest to the best of my ability that the above information is accurate and correct. (First and Last Name) *

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