Underdog Race Timing COVID Questionnaire
Read and complete this before coming to the venue.
Email address *
What is your name? *
Address *
Phone # w/ area code (for contact tracing only) *
Category
1. Have you experienced a fever of 100.4 degrees F or greater, a new cough, new loss of taste or smell, or shortness of breath within the past 10 days? *
2. In the past 10 days, have you tested positive for COVID-19 using a test that tested salivaor used a nose or throat swab (not a blood test)? (10 days measured from the date youwere tested, not the date you received the test result.) *
3. To the best of your knowledge, in the past 14 days, have you -or someone you live with been in close contact (within 6 feet/or same enclosed closed space for at least 10 minutes) with anyone while they had COVID-19, or you have reason to believe they have? *
4. In the past 14 days, have you traveled internationally or returned from a state identified by New York State as having widespread community transmission of COVID-19 (other than just passing through the restricted state for less than 24 hours)? Visithttps://coronavirus.health.ny.gov/covid-19-travel-advisory for applicable states. *
E-Signature- I attest my answers are true to the best of my knowledge. *
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