Junior Nordic Daily COVID Assessment (DCA)
Hello Hillside M/W/S 4:30pm Skiers!
Please complete the form below prior to every practice.
In case of transmission, we will be reaching out to all those who complete the log.
Thank you and Happy Trails!
* Required
Skier First & Last Name:
*
Your answer
Skier Type:
*
Choose
Polar Cub
Otter
Coach
Volunteer
Substitute Coach
Parent Name (if applicable):
Your answer
Phone Number:
*
Your answer
Email Address:
*
Your answer
COVID Screening for Skiers:
Is your Body Temperature over 100.4 or have you had a fever in the last 72hrs?
*
Yes
No
Are you experiencing an unusual cough?
*
Yes
No
Are you experiencing an unusual sore throat?
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Yes
No
Are you experiencing unusual shortness of breath?
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Yes
No
Do you have any of the following symptoms that are new or unexplained (Chills, Diarrhea, Abdominal Pain, Vomiting, Fatigue, Joint Pain, Muscle Aches, New Rash, Loss of Smell or Taste, Headache, NEW congestion, NEW runny nose)?
*
Yes
No
Have you had close contact with someone with COVID-19 in the last 14 days?
*
Yes
No
Have you traveled outside of Alaska in the last 14 days?
*
Yes
No
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