Reporting Positive COVID-19 Test
Parents/guardians and coaches are responsible for reporting information required on this form within 24 hours of a confirmed positive test for COVID-19 of a player or coach registered with the Johnston Urbandale Soccer Club. Information collected will be used to report to the Iowa Soccer Association per their most current COVID-19 Positive Test Result Policy, to communicate requirements to the affected team, and to notify other teams who were potentially exposed.
The name of the individual testing positive is NOT required, and is not captured by this form.
Reporter First Name
Reporter Last Name
Please select the team the person who tested positive for COVID-19 plays on or coaches for.
JUSC Academy C10 Atletico Madrid
JUSC Academy C10 Barcelona
JUSC Academy C10 Real Madrid
JUSC Academy C10 Sevilla
JUSC Academy C9 Liverpool
JUSC Academy C9 Man United
JUSC Academy G10 Dash
JUSC Academy G10 Red Stars
JUSC Academy G9 Thorns
JUSC C15A SS
JUSC C16A SS
JUSC C19B SS
JUSC C19C SS
Please indicate if the individual who tested positive for COVID-19 is a coach (including assistant coach) or player.
Please enter the date the individual started exhibiting COVID-19 symptoms. Leave null if asymptomatic.
Please enter the date the individual was tested positive. This should reflect the date of the test, not the date the results were received.
No Contact Coaching
If individual who tested positive for COVID-19 is a coach on the team, please confirm that no close contact practices were in place, that physical distance of 6 feet or more was maintained at practices and games with players, and a mask was worn by the coach at all times during training and games. By checking box below, you acknowledge these practices were in place.
Last Contact Date
Please enter the date the individual was in last contact with his or her team. This would be the date of the last game or practice session the individual had attended.
Please list all opponents the team came in contact with when the individual tested positive for COVID-19 was present in the past 7 days. This should include any friendly scrimmages against other club teams.
Other Household Members
Please select "Yes" if the individual who tested positive for COVID-19 has anyone within their household who also plays or coaches on a different JUSC or Sporting Iowa team. If this does not apply, select "No".
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This form was created inside of JUSC & Sporting Iowa.