Participants and coaches COVID-19 Screening Questionnaire
Barnet and District Athletics Club
Adult members COVID-19 Self Declaration Form

The safety of club members is our overriding priority, as the coronavirus pandemic continues we are monitoring the situation closely. In order to prevent the spread of the virus and reduce the risk of exposure to club members we are requiring everyone to COMPLETE AND SUBMIT this questionnaire prior to taking part in any club organised training session.

This information is required by the Government and if necessary will be shared to enable the NHS track and trace service to fulfil their role.
Sign in to Google to save your progress. Learn more
Name *
Phone Number *
In the past 14 days have you been in close proximity to anyone who has tested positive for COVID-19.? *
Have you shown any symptoms listed on the government website directly linked to the infection Covid -19? *
Has anyone in your household suffered any flu like symptoms in the last 14 days e.g high temperature, dry cough, difficulty breathing, loss of smell and taste that cannot be attributed to any other known cause? *
Have you travelled outside the UK in the last 21 days? *
Have you stayed away from your home address in the last 14 days? *
Which group are you training with? *
Data Protection
All information you provide to the NHS test and trace service is held in strict confidence and will only be kept and used in line with the Data Protection Act 2018By completing this form and taking part in a training session you are agreeing to the above information you have provided being shared within Government coronavirus guidelines if necessary.These details and forms will be destroyed in line with GDPR when the concerns regarding corona virus have subsided, or 21 days after your final attendance at a session.
Do you agree to your data to be held for this reason? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy