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
Email *
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. *
Have you been in close contact with a confirmed active case of COVID-19 within the last 14 days?
Clear selection
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.
Never submit passwords through Google Forms.
This form was created inside of UA. Report Abuse