NAFSC Daily COVID Screening Form
This form must be filled out and signed on the registered day of club ice use BEFORE being allowed on the ice.

Please complete before your skater enters the FIC building.

DO NOT FILL OUT BEFORE 6AM ON DAY OF SKATING.
Email address *
Name: *
Today's Date: *
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Within the past 24 hours, has skater/coach/employee/volunteer had a fever (100.4 and above) or used medicine for the purpose of reducing a fever? *
Required
If skater/coach/employee/volunteer has ONE (1) or more of the following new or worsening symptoms outside of another medical condition/injury, DO NOT ATTEND. Check all that apply. *
Required
If skater/coach/employee/volunteer has any TWO (2) or more of the following new or worsening symptoms outside of another medical condition/injury, DO NOT ATTEND. Check all that apply. *
Required
Has skater/coach/employee/volunteer been in close contact with a person who has COVID-19? *
Required
Has skater/coach/employee/volunteer travelled outside the State of Maine in the past 10 days anywhere other than states currently exempted by the Governor's mandate OR travelled to Maine from an area not exempted by the Governor's mandate? *
Required
IF ANY OF YOUR ANSWERS ABOVE INDICATE YOU SHOULD NOT ATTEND, PLEASE DO NOT ATTEND. IF YOU DEVELOP SYMPTOMS WITHIN 48 HOURS OF BEING AT CLUB ICE AND TEST POSITIVE FOR COVID-19, PLEASE CONTACT NAFSC at presidentnafsc@gmail.com IMMEDIATELY. ALL INFORMATION WILL REMAIN CONFIDENTIAL.
A copy of your responses will be emailed to the address you provided.
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