Self-Screening Checklist | Fall 2020
The safety and well-being of our swimmers and staff continue to be our highest priority. This self-screening daily checklist is part of our COVID-19 safety guidelines. Please answer each daily health question with a "Yes" or "No". In accordance with our guidelines, once you have completed and submitted this form you will receive an email with the screening results that must be presented to the staff member at check-in.
The Self-Screen Participation Email will be sent to the address entered below.
Email Address *
Enter the email address where you want to receive the Self-Screening Participation Email.
Name *
Please the FIRST AND LAST NAME of the swimmer.
Swimmer Symptom Check *
Please review the list of symptoms checking "Yes" if you have this symptom and "No" if you do not have the symptom.
Fever or Chills
Nasal Congestion or Runny Nose
Sore Throat
Shortness of Breath or Difficulty Breathing
Nausea or Vomiting
Muscle or Body Aches
New Loss of Taste or Smell
Fever (if higher than 100.3)
The requirement to self-quarantine and complete the Travel Health Form ( is applicable to any traveler who has spent twenty-four (24) hours or longer in an affected state within fourteen (14) days prior to arriving in Connecticut but does not include an individual remaining in Connecticut for less than twenty-four (24) hours. These requirements are also applicable to Connecticut residents who are returning from a visit to an affected state. The list of States as of September 1st are as follows: Alabama, Alaska, Arkansas, Delaware, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Oklahoma, Puerto Rico, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin
How you been in close contact with any person who has recently been tested positive for COVID-19?
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