COVID-19 Athlete Questionnaire
To be completed prior to attending, training sessions and competitions.

CONFIDENTIALITY
All information is provided in strict confidence and will not be shared with others. If information provided requires further clarification you will be contact prior to the session/competition.
Email *
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First & Last name *
Contact telephone # *
Countries you visited or stayed in the last 14 days *
Have you had close contact with anyone diagnosed as having COVID-19? *
Required
You or a co-resident provided direct care for COVID-19 patients? *
Required
Visited or stayed in a closed environment with any patient having COVID-19? *
Required
Worked together in close proximity, or sharing the same classroom environment with a COVID-19 patient? *
Required
Traveled together with a COVID-19 patient in any kind of conveyance? *
Required
Lived in the same household as a COVID-19 patient? *
Required
Have you stayed or visited a Government quarantine or isolation centre? *
Required
Tested positive based on a swab PCR test? *
Required
Did you arrive to Barbados on an airplane within the last two weeks? *
If you arrived by airplane within the last two weeks what was the date and result of last COVID test?
Experienced any of the the following symptoms now and in the previous 14 days: *
Yes
No
Fever (greater than 100.4F or 38C)
Cough
Fatigue
Dyspnea (shortness of breath)
Myalgia (muscle pain)
Sore throat
Chest pain
Congestion/Coryza
Headache
Chills
Nausea/Vomiting
Diarrhea
Anosmia (loss of smell)
Dysgeusia/Ageusia/hypogeusia (distortion of taste, loss of taste, decrease in taste sensitivity)
Chilblains/Pernio (itching, red patches, swelling and blistering of the skin)
Are you or do you have any of the following? *
Yes
No
Diabetes
Asthma
Chronic lung disease
Heart conditions
Chronic kidney disease
Liver disease
Immunocompromised (weakened immune system)
Hypertension
Over age 65
Are there any injuries current or recent that may affect your ability to perform physical activity? *
Name of person completing the form, if form is for a person under the age of 18, a parent/guardian must attach their name. *
A copy of your responses will be emailed to the address you provided.
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