COVID SYMPTOM SCREENING QUESTIONNAIRE 2021
As you will be aware, as a result of the COVID-19 pandemic, medical staff will be conducting a daily routine screening of new health symptoms in all players and staff. This is to protect your health and safety, and those of others at the club.

If you have had any of these symptoms, please report it to your medical staff immediately BEFORE ATTENDING training

*Indicates most sensitive symptoms

Objective fever defined as 37.6oC

*Most individuals that are positive for COVID-19 do not appear to have a fever

RECORD SHEET FOR POSSIBLE/CONFIRMED COVID-19 CASE
Please insert your child's name *
Please tick child's age group
Please tick if applicable
U8
U9
U10
U11
U12
U13
U14
U15
U16
U18 (Youth Team)
STAFF
Please insert the date of training/fixture *
MM
/
DD
/
YYYY
Today, have you had:
Please tick if applicable
New Cough*
Fever/Temperature*
Unusually Short of Breath during exercise or at rest*
Loss of Smell*
Loss of Taste*
Red Eyes or Sticky Eyes
New Abdominal Pain or Diarrhoea
New Blocked/Runny Nose
New unusual fatigue with muscle and joint pains
Headache
Feeling generally unwell in any other way
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