CRSL 2020 COVID-19 Questionnaire
This form must be completed for each player prior to each practice and game.
Email address *
Date *
MM
/
DD
/
YYYY
Player First Name *
Player Last Name *
Name of person completing form *
Team Name *
Is the player experiencing any of the following symptoms: *
YES
NO
Fever (≥ 100.4°F)
Cough or shortness of breath
Sore Throat
Chills
Muscle Aches or Rigors
Headache
New loss of taste or smell
Abdominal pain, nausea, vomiting or diarrhea
Have you had close contact with someone who is currently sick?
Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?
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