COVID-19 Athlete Self-Check Form
The Woodstock Dolphins Coaches and Board of Directors are dedicated to ensuring the safety of all of our athletes and families. As such, during the COVID-19 pandemic it is important to understand when your swimmer should not be coming into practice. This form will be used to assess your swimmer's health daily to determine his/her ability to safely continue practicing.
Name* (Last, First) *
Contact* (Phone or Email) *
Swimmer practice level
Fever (100.4 or higher)? *
Dry Consistent Cough? *
Shortness of Breath or difficulty breathing / Congestion or runny nose? *
Diarrhea (not due to preexisting conditions)? *
Muscle pain / Repeated shaking with chills? *
Unusual continuous headache for more than 48 hours? *
Sore throat / Loss of sense of taste and / or smell? *
In the past 14 days, have you been in close physical contact, sustained communication face-to-face for 2-3 minutes or direct physical contact, within 6 feet for 2-3 minutes with someone that has a confirmed case of COVID-19? *
In the past 14 days, have you been in close physical contact, sustained communication face-to-face for 2-3 minutes or direct physical contact, within 6 feet for 2-3 minutes with someone displaying any of the following COVID-19 symptoms? Fever (100.4 or higher), Dry Consistent Cough, Shortness of breath / difficulty breathing, Congestion or runny nose, Diarrhea, Muscle pain / repeated shaking with chills, Sore throat / loss of sense of taste and/or smell? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy