CO-Vid19 - Questionaire - Vipers

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Onboarding #6 -CO-VID19 - Questionnaire

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CO-Vid19 - Questionaire

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Have you experienced any of the following symptoms of COVID-19 within the last 48 hours?

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Fever or chills

Yes No

Cough

yes no

Shortness of breath or difficulty breathing

Yes No

Fatigue

Yes No

Muscle or body aches

Yes No

Headache

Yes No

New loss of taste or smell

Yes No

Sore throat

Yes No

Congestion or runny nose

Yes No

Nausea or vomiting

Yes No

Diarrhea

Yes No

Have you tested positive for COVID-19 in the past 10 days?

Are you currently awaiting results from a COVID-19 test?

Are you Vaccinated? if not have you taken a PCR in the last 14 days?

Have you been diagnosed with COVID-19 by a licensed healthcare provider (for example, a doctor, nurs

Have you been told that you are suspected to have COVID-19 by a licensed healthcare provider in the

Yes No

Please Notify us if:

You MUST inform coach if you:
 Receive a confirmed positive COVID-19 test result;
 Have been diagnosed with COVID-19 by a licensed healthcare provider;
 Have been told you are suspected to have COVID-19 by a licensed healthcare provider;
 Experience new loss of taste and/or smell with no other explanation; or
 Experience both fever (≥100.4° F) and new unexplained cough associated with shortness of breath

If I show any symptoms OF CO-VID19 -

If i show any symptoms of Co-Vid19. I will not report to any appearances or practices nor games until I have received a negative PCR test.

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