COVID-19 Report Form
Please report any contact or symptoms of COVID-19. This would include any family members that have tested positive, or contact with a positive case outside of basketball. Also, describe any symptoms that may be COVID-19 related.
Player Name *
Email address *
Team Name *
Symptoms
First Date of Symptom
MM
/
DD
/
YYYY
Date of COVID-19 Test Taken
MM
/
DD
/
YYYY
Date of COVID-19 Result Received
MM
/
DD
/
YYYY
COVID-19 Test Result
Clear selection
Date of Close Contact
MM
/
DD
/
YYYY
Late Date of Contact with Team
MM
/
DD
/
YYYY
Any additional information
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