FVSEF COVID-19 Screening Self-Report Form
FVSEF, P.O. Box 623, Whitefish, MT 59937
Contact us at (406)885-2730 or
This form must be filled out by all athletes, coaches and volunteers BEFORE attending any FVSEF training, competition or other events.
1. First Name
2. Last Name
3. If the person named above is a minor, are you his/her parent or guardian?
N/A - I am over 18
4. The named above is an
5. If you checked "Athlete" above, please Indicate your Training Group
All Mountain Rangers
N/A (I am not registered as an athlete)
6. Have you or anyone in your household returned from travel outside the Flathead County in the last 14 days? (This question is for contact tracing only. Answering "yes" to this question alone will not restrict your participation in FVSEF activities.)
7. Are you or is anyone in your household a confirmed contact of a person confirmed to have COVID-19?
8. Have you experienced any COVID-19 symptoms in the last 24hrs (e.g. cough, shortness of breath, fever, chills, muscle pain, headache, sore throat, new loss of taste of smell, vomiting, nausea, diarrhea)? If Yes - Please select all symptoms experienced
shortness of breath
new loss of taste of smell
9. If you answered NO to questions 7 AND 8 above, please skip this question and proceed to "Submit". IF YOU ANSWERED YES TO QUESTION 7 OR 8, PLEASE CHECK BOTH BOXES BELOW AND DO NOT ATTEND FVSEF ACTIVITIES UNTIL YOU HAVE TESTED NEGATIVE FOR COVID-19 OR QUARANTINED APPROPRIATELY.
I agree to stay home and not attend any FVSEF activities today
I agree to contact my coach to confirm the reason for my absence from today's activity
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