Return to Play COVID-19 Health Screening Adults
The purpose of this screen is to inform and make you aware of the risks involved in returning to train
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Terms & Conditions
Before returning to training please accurately complete and submit the form below:
First Name *
Surname *
Email Address *
Have you had confirmed COVID-19 infection or any symptoms (listed below) in keeping with COVID-19 in the last two weeks - Fever, Persistent dry cough, loss of taste or smell? *
If ‘Yes’, please provide details:
If anyone answers yes to this question, NHS advice is, they should get a test to check if they have coronavirus as soon as possible. Stay at home and do not have visitors until they get their test results – only leave home to get a test.
Have you had a known exposure to anyone with confirmed or suspected COVID-19 in the last two weeks? (e.g. close contact, household member) *
If ‘Yes’, please provide details:
Not allowed to train until you have self-isolated for 14 days.
Do you have any underlying medical conditions? (Examples include: respiratory conditions including asthma; heart, kidney, liver or neurological conditions; diabetes mellitus; a spleen or immune system condition; currently taking medicines that affect your immune system such as steroid tablets). *
If ‘Yes’, please provide details:
If you have an underlying medical condition that makes you more susceptible to poor outcomes with COVID-19 (including age >65) then you should consider the increased risk and may want to discuss this with you usual medical practitioner
Do you live with or will you knowingly come into close contact with someone who is currently ‘shielding’ or otherwise medically vulnerable if you return to the training environment? *
If ‘Yes’, please provide details:
This is an individual call, but awareness of risks and the appropriate precautions should be taken.
Sought Medical Advice
Clear selection
If ‘Yes’, please provide details:
Able to train: *
Signed *
Date *
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