Nanook Rec COVID-19 Health Screening Questionnaire
This form must be filled out less than 24 hours prior to your visit to a UAF Nanook Recreation facility (SRC, Patty Ice, Patty Pool).
RETURNING PARTICIPANTS: you must fill this form out before each visit.
If you are experiencing COVID-19 symptoms or have been in close contact with an active case COVID-19 in the last 14 days, you are not allowed to enter a Nanook Recreation facility. If you have not followed the University of Alaska policy on travel, you are not allowed to enter a Nanook Recreation facility. As another option, see our online workout classes on our website at
Facility ENTRANCE Date (must be within the next 24 hours & not a birth date)
Participant name (provide a name that matches Nanook Recreation records)
What are you experiencing currently? Please mark all that apply.
shortness of breath
fever in the last 48 hours
new loss of taste or smell
vomiting or diarrhea in the last 24 hours
I have no flu like Covid-19 associated symptoms
Have you been in close contact with a confirmed active case of COVID-19 within the last 14 days?
After Travel: according to UA policy & AK State mandates, students & non-students need to have a COVID-19 negative test result and have isolated for 5 days before resuming normal activities, including use of the SRC, Ice Arena, & Pool. By entering one of these facilities, would you be violating that policy?
A copy of your responses will be emailed to the address you provided.
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