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.
Sign in to Google to save your progress. Learn more
First Name *
Surname *
Email Address *
Contact Number *
Have you recently developed a new, continuous cough? *
Do you feel as though you have a high (above 37.8°C) temperature? *
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? *
Have you recently suffered a shortness of breath, a loss, or change to, your sense of smell/taste? *
Which Southbank squad have you been selected to play for today? (Apt on match-days only)
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/ *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms