Southbank CUACO COVID-19 Self Assessment
Could all players & volunteers kindly fill out this form before EACH training session & match day. Failure to do so may result in a delayed start (once you have filled it out) or you may be asked to leave.
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First Name
*
Your answer
Surname
*
Your answer
Email Address
*
Your answer
Contact Number
*
Your answer
Have you recently developed a new, continuous cough?
*
Choose
Yes
No
Do you feel as though you have a high (above 37.8°C) temperature?
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Yes
No
Have you recently been in close contact with/living with someone with a suspected or confirmed case of COVID-19 in the last two weeks?
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Choose
Yes
No
Have you recently suffered a shortness of breath, a loss, or change to, your sense of smell/taste?
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Choose
Yes
No
Which Southbank squad have you been selected to play for today? (Apt on match-days only)
Choose
1s
2s
3s
4s
5s
6s
7s
8s
9s
10s
Lastly, have you read and do you agree with the Southbank CUACO privacy/GDPR policy & also the Code of Conduct policy? This can be obtained here:
http://www.southbankcuaco.co.uk/covid-code-of-behaviour/
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