SwimSkills Daily Covid19 Health Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Required daily online wellness survey for swimmers, staff and volunteers. This form must be completed before entering the facility. Entrance to the facility will not be permitted without the completed form.

Date *

YYYY

Last Name *

First Name *

Chose your group *

Blue

Bronze

Silver

Gold

Staff

Do you feel well today? *

Yes

Have you felt sick in the past 24 hours? *

Yes

Are you currently experiencing any of the following symptoms? (Please choose yes or no for each) *

Yes

Fever

Difficulty breathing

Chest pain

Sore throat

Chills

Runny nose

Sneezing Coughing

Headache

Abnormal muscle aches

Gastro illness

Loss of smell

Loss of taste

Have you been in contact with anyone who has traveled outside of Canada within the past 14 days? *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms