COVID Health Screening Questionnaire
Email address *
Within the last 10 days have you or those swimming been diagnosed with COVID-19 or had a test confirming you or those swimming have the virus? *
Do you or those swimming live in the same household with, or have you had close contact* with someone in the past 14 days who has been in isolation for COVID-19 or had a test confirming they have the virus? (*NOTE: ʺClose Contactʺ is defined as living in the same house, being an intimate partner, being a caregiver, or being within 6 feet of an individual for longer than 15 minutes who has COVID-19) *
Have you or those swimming had a fever of 100 Fahrenheit (37.8 Celsius) or higher in the past 14 days? *
Have you or those swimming had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by a reason other than possibly having COVID-19? COVID related symptoms include: Fever, cough, sore throat, shortness of breath/difficulty breathing, feeling unusually weak/fatigued, loss of taste/smell, muscle pain, headache, runny/congested nose, diarrhea, nausea and vomiting. *
By electronically signing below, and to the best of your knowledge, I attest that the answers I have indicated above are true. To electronically sign, type your name below. *
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