AKRFC COVID Questionnaire
COVID Questionnaire - All participants and spectators need to fill this out prior to each session.
Email *
Date *
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YYYY
Name *
Which group are you participating with? *
Is your temperature greater than or equal to 100.0 degrees Fahrenheit? *
Are you currently experiencing, or have you recently experienced ANY of the following symptoms? Cough (new or worsening), Shortness of Breath (new or worsening), Troubled Breathing (new or worsening), Fever (above 100.0 degrees Fahrenheit), Chills, Muscle Pain or Body Aches (new or worsening), Headache (new or worsening), Sore Throat (new or worsening), New Loss of Taste, New Loss of Smell, Fatigue, Congestion or Runny Nose, Nausea or Vomiting, Diarrhea *
Have you had any known close contact with a person confirmed (by diagnostic test) or suspected (based on symptoms) to have COVID-19 within the past 10 days? *
Have you tested positive for COVID-19 through a diagnostic test within the past 10 days? *
If any answers are YES, you are required to present a negative test result to resume participation.
A copy of your responses will be emailed to the address you provided.
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