Women's Soccer Visiting Team COVID-19 Screening Questionnaire
Email
Secondary Email
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Are you an athlete or coach? *
Athlete
Coach
First Name *
Last Initial *
School Name *
Phone Number *
Email address *
Have you been in close contact unmasked with someone who has been diagnosed with Coronavirus within the last 14 days? (Close contact is < 6 feet for ≥15 minutes) *If participant has tested positive for COVID-19 within the past 90 days, this exposure item is rendered moot. *
Yes
No
Do you currently have a temperature of 100.4 or greater? *
Yes
No
Do you have repeated shaking or chills? *
Yes
No
Do you have a new loss of smell and/or taste? *
Yes
No
Do you have shortness of breath that is not associated with a preexisting condition (i.e asthma)? *
Yes
No
Do you have a cough (new or different than normal)? *
Yes
No
Do you have muscle or body aches? *
Yes
No
Do you have diarrhea/upset stomach/nausea? *
Yes
No
Do you have a sore throat? *
Yes
No
Do you have a headache? *
Yes
No
Do you have congestion that is not associated with a preexisting condition (i.e allergies)? *
Yes
No
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