Creekwood COVID-19 Daily Screening Questionnaire

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Complete this form DAILY before you enter the pool gate. Complete one questionnaire per swimmer. If you answer "yes" to any of these questions, access cannot be granted to the pool.

Email *

Swimmer/Resident Name (First and Last) *

Today's Date *

YYYY

Have you had any contact with or cared for a person with a confirmed or suspected case of COVID-19 within the last 14 days? *

Yes

Have you traveled internationally in the last 14 days? *

Yes

Are you currently experiencing fever (100.4degrees Fahrenheit or higher) or a sense of having a fever, a new cough that cannot be attributed to another health condition, new shortness of breath that cannot be attributed to another health condition, new chills that cannot be attributed to another health condition, a new sore throat that cannot be attributed to another health condition, or new muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise)? *

Yes

If "Yes " to any of the above questions, please list an explanation or symptoms below:

Your "Signature" or Parent/Guardian Name if swimmer is under 18 years of age. *

A copy of your responses will be emailed to the address you provided.

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