COVID-19 Exposure Response Form
This form is intended for coaches, staff, parents & volunteers to report any COVID-19 exposure or risk of exposure to prevent spread of the virus during Alexandria Soccer Association (ASA) hosted activities.
STEP 1 — Report possible COVID-19 exposures in this form. IF a staff member or coach becomes aware of any staff member, coach or participant that falls under any of the screening questions, they should collaborate with that person/family to complete this COVID-19 Exposure Response Form to ensure proper steps have been taken to eliminate risk for future spread.
STEP 2 — ASA staff will follow up with the reporting person, staff member or coach to confirm details, assess the exposure scenario, and align on next steps.
STEP 3 -- Reporting person, ASA staff member or coach (with guidance) will communicate with the participant and/or participant's family on appropriate next steps.
If you have any questions about COVID-19, ASA protocols or this COVID-19 Exposure Response Form, please reach out to the closest ASA front-office staff member for guidance. Thank you for your attention to this and for supporting the safety of our Alexandria community.
(If answer “yes” to any of the below questions, please have staff member, coach or participant stay home)
(1) Have you received a positive test result for COVID-19?
(2) Have you experienced any cold or flu-like symptoms in the last 10 days (to include fever, cough, sore throat, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste/smell, sore throat, congestion or runny nose, diarrhea, nausea or vomiting)?
(3) Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 10 days?
(4) Have you had close contact with or cared for someone who has experienced symptoms of COVID-19 within the last 10 days but has not been tested?